Provider Demographics
NPI:1073290995
Name:DANG, MICHELLE MYTIEN (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MYTIEN
Last Name:DANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5914 GENTLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-1684
Mailing Address - Country:US
Mailing Address - Phone:832-420-7860
Mailing Address - Fax:
Practice Address - Street 1:6565 WEST LOOP S STE 650
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3505
Practice Address - Country:US
Practice Address - Phone:713-797-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10857T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist