MEDICARE: LOI THANH MAI 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	894	NV
2	152W00000X	Optometrist	34111	CA

General Provider Information

NPI Number	:	1902353238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOI THANH MAI O.D.

Provider Business Mailing Address
First Line	:	507 S EUCLID ST SPC 123
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-1078
Country	:	US
Telephone Number	:	714-724-1540
Fax Number	:

Provider Business Practice Location Address
First Line	:	1509 N MAIN ST STE J
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92701-7418
Country	:	US
Telephone Number	:	714-542-2226
Fax Number	:	714-550-7254

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

Provider Enumeration Date	:	09/02/2016
Last Update Date	:	02/07/2019

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Directions to “ LOI THANH MAI O.D.” Practice Location

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