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General NPI Number Information
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NPI Number | 1518249366
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Entity Type | Organization
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Legal Business Name | THAO MAI, LLC
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Dates
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Enumeration Date | 09/16/2011
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Last Update Date | 09/16/2011
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Provider Practice Location Address
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Address Line | 4810 LAPALCO BLVD
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City | MARRERO
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State | LA
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Zip | 70072-4382
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Country | US
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Telephone | 504-341-0818
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Fax |
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Provider Business Mailing Address
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Address Line | 20 NOTTOWAY DR
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City | MARRERO
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State | LA
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Zip | 70072-5077
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Country | US
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Telephone | 504-723-3546
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | THAO MAI
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Credential | OD
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Telephone | 504-723-3546
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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 | 1530-567T
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License Number State | LA
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