Provider Demographics
NPI:1558438101
Name:DUNG, THAO M (OPTOMETRIST)
Entity Type:Individual
Prefix:DR
First Name:THAO
Middle Name:M
Last Name:DUNG
Suffix:
Gender:F
Credentials:OPTOMETRIST
Other - Prefix:DR
Other - First Name:THAO
Other - Middle Name:
Other - Last Name:DUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:
Practice Address - Street 1:1 WASHINGTON ST STE 101
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-1706
Practice Address - Country:US
Practice Address - Phone:781-263-7360
Practice Address - Fax:510-799-7734
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11418T152W00000X
MAOPT5329152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU91399Medicare UPIN
CAZZZ03731ZMedicare ID - Type Unspecified
CASD0114181Medicare ID - Type Unspecified