Provider Demographics
NPI:1447800446
Name:DOAN, TAVIA THO-KIM (OD)
Entity Type:Individual
Prefix:
First Name:TAVIA
Middle Name:THO-KIM
Last Name:DOAN
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 1:811 NE ALSBURY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-2657
Mailing Address - Country:US
Mailing Address - Phone:817-231-7131
Mailing Address - Fax:
Practice Address - Street 1:811 NE ALSBURY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-2657
Practice Address - Country:US
Practice Address - Phone:817-231-7131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT9859152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist