MEDICARE: DR. THUYTRINH LIEU O.D.

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	7995TG	TX

General Provider Information

NPI Number	:	1346505476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THUYTRINH LIEU O.D.

Provider Business Mailing Address
First Line	:	3201 GRAND BAY DR
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75040-5543
Country	:	US
Telephone Number	:	817-266-6691
Fax Number	:

Provider Business Practice Location Address
First Line	:	8687 N CENTRAL EXPY
Second Line	:	#2200
City	:	DALLAS
State	:	TX
Zip	:	75225-4427
Country	:	US
Telephone Number	:	214-368-0059
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2012
Last Update Date	:	12/28/2015

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