Provider Demographics
NPI:1629189444
Name:LA, THUY-TRANG MAI (OD)
Entity Type:Individual
Prefix:DR
First Name:THUY-TRANG
Middle Name:MAI
Last Name:LA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:TANIA
Other - Middle Name:
Other - Last Name:LA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:8861 DAVIS BLVD 102
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-0306
Mailing Address - Country:US
Mailing Address - Phone:817-562-2020
Mailing Address - Fax:817-562-2225
Practice Address - Street 1:8861 DAVIS BLVD 102
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-0306
Practice Address - Country:US
Practice Address - Phone:817-562-2020
Practice Address - Fax:817-562-2225
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6225TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist