Provider Demographics
NPI:1770236390
Name:TOAN THACH, O.D.
Entity Type:Organization
Organization Name:TOAN THACH, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:TOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:THACH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:562-912-9248
Mailing Address - Street 1:119 HICKEY BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-1145
Mailing Address - Country:US
Mailing Address - Phone:562-912-9248
Mailing Address - Fax:
Practice Address - Street 1:133 SERRAMONTE CTR
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2349
Practice Address - Country:US
Practice Address - Phone:562-912-9248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty