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General NPI Number Information
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NPI Number | 1053552141
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Entity Type | Organization
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Legal Business Name | THUY T HA OD INC
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Dates
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Enumeration Date | 03/18/2009
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Last Update Date | 08/05/2023
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Provider Practice Location Address
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Address Line | 8694 ELK GROVE BLVD STE 7
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City | ELK GROVE
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State | CA
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Zip | 95624-1753
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Country | US
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Telephone | 916-685-3369
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Fax | 916-685-2020
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Provider Business Mailing Address
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Address Line | 8694 ELK GROVE BLVD STE 7
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City | ELK GROVE
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State | CA
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Zip | 95624-1753
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Country | US
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Telephone | 916-685-3369
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Fax | 916-685-2020
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. THUY T HA
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Credential | OD
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Telephone | 916-685-3369
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 13097TPA
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License Number State | CA
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