Provider Demographics
NPI:1114044609
Name:THAZIN AUNG OD
Entity Type:Organization
Organization Name:THAZIN AUNG OD
Other - Org Name:PALO ALTO EYES OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THAZIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-321-2015
Mailing Address - Street 1:540 UNIVERSITY AVE
Mailing Address - Street 2:#110
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301
Mailing Address - Country:US
Mailing Address - Phone:650-321-2015
Mailing Address - Fax:650-321-2489
Practice Address - Street 1:540 UNIVERSITY AVE
Practice Address - Street 2:#110
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301
Practice Address - Country:US
Practice Address - Phone:650-321-2015
Practice Address - Fax:650-321-2489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7002T152W00000X
CA15044152W00000X
CAOPT7002TPA152W00000X
CAOPT7019TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1346271665OtherNPI#
CA1568526440OtherNPI#
CA1568526440OtherNPI#