Provider Demographics
NPI:1003181421
Name:T THIEU OD LLC
Entity Type:Organization
Organization Name:T THIEU OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THANH-THAO
Authorized Official - Middle Name:
Authorized Official - Last Name:THIEU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-997-0411
Mailing Address - Street 1:3425 LIMEKILN PIKE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-3602
Mailing Address - Country:US
Mailing Address - Phone:215-997-0411
Mailing Address - Fax:
Practice Address - Street 1:3425 LIMEKILN PIKE
Practice Address - Street 2:SUITE 2
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-3602
Practice Address - Country:US
Practice Address - Phone:215-997-0411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001198152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty