MEDICARE: LOI THANH MAI OD INC

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

General Provider Information

NPI Number	:	1083436356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOI THANH MAI OD INC

Provider Business Mailing Address
First Line	:	1725 E OAKRIDGE CIR
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91792-1939
Country	:	US
Telephone Number	:	714-724-1540
Fax Number	:

Provider Business Practice Location Address
First Line	:	16106 BELLFLOWER BLVD
Second Line	:
City	:	BELLFLOWER
State	:	CA
Zip	:	90706-4606
Country	:	US
Telephone Number	:	562-867-4716
Fax Number	:

Authorized Official
Title or Position	:	CEO/CFO
Name	:	LOI THANH MAI
Credential	:	OD
Telephone Number	:	714-724-1540

Provider Enumeration Date	:	10/29/2024
Last Update Date	:	10/29/2024

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