Provider Demographics
NPI:1669481610
Name:OO, THAN TUN (MBBS, DO)
Entity Type:Individual
Prefix:DR
First Name:THAN
Middle Name:TUN
Last Name:OO
Suffix:
Gender:M
Credentials:MBBS, DO
Other - Prefix:DR
Other - First Name:ERNEST
Other - Middle Name:THAN TUN
Other - Last Name:OO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MBBS, DO
Mailing Address - Street 1:TURNER STREET, FAGATOGO
Mailing Address - Street 2:LBJ TROPICAL MEDICAL CENTER
Mailing Address - City:PAGO PAGO AMERICAN SAMOA
Mailing Address - State:AS
Mailing Address - Zip Code:96799-1684
Mailing Address - Country:US
Mailing Address - Phone:684-633-1222
Mailing Address - Fax:684-633-5913
Practice Address - Street 1:TURNER STREET, FAGATOGO
Practice Address - Street 2:LBJ TROPICAL MEDICAL CENTER
Practice Address - City:PAGO PAGO AMERICAN SAMOA
Practice Address - State:AS
Practice Address - Zip Code:96799-1684
Practice Address - Country:US
Practice Address - Phone:684-633-1222
Practice Address - Fax:684-633-5913
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AS3063-C207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology