Healthcare Provider Details

I. General information

NPI: 1396361085
Provider Name (Legal Business Name): TU DAO OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6818 HEUERMANN RD
SAN ANTONIO TX
78256-9665
US

IV. Provider business mailing address

6818 HEUERMANN RD
SAN ANTONIO TX
78256-9665
US

V. Phone/Fax

Practice location:
  • Phone: 210-308-5550
  • Fax: 210-308-6161
Mailing address:
  • Phone: 210-308-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number9983T
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9983TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: