MEDICARE: DR. THAO NGOC NGO OD

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	9155T	TX

General Provider Information

NPI Number	:	1710408521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THAO NGOC NGO OD

Provider Business Mailing Address
First Line	:	350 E INTERSTATE 20
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76018-1119
Country	:	US
Telephone Number	:	682-521-7919
Fax Number	:	817-467-5819

Provider Business Practice Location Address
First Line	:	2108 DALLAS PKWY STE 206
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4362
Country	:	US
Telephone Number	:	866-755-2026
Fax Number	:	817-467-5819

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

Provider Enumeration Date	:	06/30/2017
Last Update Date	:	05/07/2025

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