Provider Demographics
NPI:1114006954
Name:LO, XINMIAN (OD)
Entity Type:Individual
Prefix:
First Name:XINMIAN
Middle Name:
Last Name:LO
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 1:5409 CHANNEL ISLE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4816
Mailing Address - Country:US
Mailing Address - Phone:469-619-5019
Mailing Address - Fax:
Practice Address - Street 1:16731 COIT RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1750
Practice Address - Country:US
Practice Address - Phone:972-250-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5781T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204717OtherCOLE MANAGED CARE