Provider Demographics
NPI:1710980479
Name:TAO, TONY YU
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:YU
Last Name:TAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:YU
Other - Middle Name:
Other - Last Name:TAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1150 N WATTERS RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5508
Mailing Address - Country:US
Mailing Address - Phone:469-235-2131
Mailing Address - Fax:
Practice Address - Street 1:1150 N WATTERS RD
Practice Address - Street 2:SUITE 107
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5508
Practice Address - Country:US
Practice Address - Phone:972-359-8828
Practice Address - Fax:972-359-9010
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5886TG152WC0802X, 152WP0200X, 152WS0006X, 152WX0102X
TX5886152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1430241-02Medicaid
TX8A0337Medicare ID - Type Unspecified