Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OPT002612 | GA |
NPI | 1306146154 |
---|---|
Provider Name | Thanh Dau |
First Address | Vienna, VA 22182-3970 |
Second Address | Lawrenceville, GA 30045 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2010 |
Last Update Date | 30/01/2016 |