MEDICARE: T THIEU OD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OEG001198	PA

General Provider Information

NPI Number	:	1003181421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	T THIEU OD LLC

Provider Business Mailing Address
First Line	:	3425 LIMEKILN PIKE
Second Line	:	SUITE 2
City	:	CHALFONT
State	:	PA
Zip	:	18914-3602
Country	:	US
Telephone Number	:	215-997-0411
Fax Number	:

Provider Business Practice Location Address
First Line	:	3425 LIMEKILN PIKE
Second Line	:	SUITE 2
City	:	CHALFONT
State	:	PA
Zip	:	18914-3602
Country	:	US
Telephone Number	:	215-997-0411
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	THANH-THAO THIEU
Credential	:
Telephone Number	:	215-997-0411

Provider Enumeration Date	:	03/19/2012
Last Update Date	:	03/16/2015

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