Provider Demographics
NPI:1114282373
Name:DINH, DAVID THANH (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:THANH
Last Name:DINH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 LUCAS DRIVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219
Mailing Address - Country:US
Mailing Address - Phone:214-528-7948
Mailing Address - Fax:214-528-7387
Practice Address - Street 1:2525 LUCAS DRIVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219
Practice Address - Country:US
Practice Address - Phone:214-528-7948
Practice Address - Fax:214-528-7387
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7990T152W00000X
TX7990TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112409105Medicaid
TX1124091-04Medicaid
TX00395ZMedicare UPIN
TX1124091-04Medicaid