Provider Demographics
NPI:1245233907
Name:DR. TONY Y. TAO, OPTOMETRIST & ASSOCIATES P.A.
Entity Type:Organization
Organization Name:DR. TONY Y. TAO, OPTOMETRIST & ASSOCIATES P.A.
Other - Org Name:YU TAO
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YU
Authorized Official - Middle Name:
Authorized Official - Last Name:TAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-359-8828
Mailing Address - Street 1:1150 N WATTERS RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5508
Mailing Address - Country:US
Mailing Address - Phone:972-359-8828
Mailing Address - Fax:972-359-9010
Practice Address - Street 1:1150 N WATTERS RD
Practice Address - Street 2:SUITE 107
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5508
Practice Address - Country:US
Practice Address - Phone:972-359-8828
Practice Address - Fax:972-359-9010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5886TG152WC0802X, 152WP0200X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Multi-Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1655797-01Medicaid
TX00283UMedicare ID - Type Unspecified