Provider Demographics
NPI:1790263663
Name:TA, ANH V (OD)
Entity Type:Individual
Prefix:MRS
First Name:ANH
Middle Name:V
Last Name:TA
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 1:64185 HWY 41 ST. B
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:LA
Mailing Address - Zip Code:70452
Mailing Address - Country:US
Mailing Address - Phone:985-250-8000
Mailing Address - Fax:985-250-8001
Practice Address - Street 1:64185 HWY 41 ST. B
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:LA
Practice Address - Zip Code:70452
Practice Address - Country:US
Practice Address - Phone:985-250-8000
Practice Address - Fax:985-250-8001
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1870-805AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1870-805ATMedicaid