Provider Demographics
NPI:1114278637
Name:YATH, THUY NGOC (OD)
Entity Type:Individual
Prefix:DR
First Name:THUY
Middle Name:NGOC
Last Name:YATH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4205 W ANTHEM WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-0445
Mailing Address - Country:US
Mailing Address - Phone:623-879-3937
Mailing Address - Fax:623-551-2051
Practice Address - Street 1:4205 W ANTHEM WAY STE 101
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-0445
Practice Address - Country:US
Practice Address - Phone:623-879-3937
Practice Address - Fax:623-551-2051
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1881152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist