Provider Demographics
NPI:1578569653
Name:DOAN, TUYET K (OD)
Entity Type:Individual
Prefix:DR
First Name:TUYET
Middle Name:K
Last Name:DOAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:TUYET
Other - Middle Name:KATHLEEN
Other - Last Name:DOAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-1205
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-938-2650
Practice Address - Street 1:2946 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7861
Practice Address - Country:US
Practice Address - Phone:636-240-1516
Practice Address - Fax:636-272-1323
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002017418152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO319187407Medicaid
MO029006438Medicare PIN
MO319187407Medicaid