Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 9216T | TX |
NPI | 1013438464 |
---|---|
Provider Name | Jennifer Thai |
First Address | Austin, TX 78749-1473 |
Second Address | Austin, TX 78749-1473 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2017 |
Last Update Date | 06/07/2017 |