Provider Demographics
NPI:1588634497
Name:THIEU, THANH-THAO (OD)
Entity Type:Individual
Prefix:
First Name:THANH-THAO
Middle Name:
Last Name:THIEU
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 1:3425 LIMEKILN PIKE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-3602
Mailing Address - Country:US
Mailing Address - Phone:215-997-0411
Mailing Address - Fax:
Practice Address - Street 1:3425 LIMEKILN PIKE
Practice Address - Street 2:SUITE 2
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-3602
Practice Address - Country:US
Practice Address - Phone:215-997-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001198152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026589540001Medicaid
PA1026589540001Medicaid