Provider Demographics
NPI:1821721317
Name:DANG, MARY THUY TIEN (OD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:THUY TIEN
Last Name:DANG
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 1:305 W FM 1382 STE 524B
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-1890
Mailing Address - Country:US
Mailing Address - Phone:833-362-8789
Mailing Address - Fax:
Practice Address - Street 1:305 W FM 1382 STE 524B
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-1890
Practice Address - Country:US
Practice Address - Phone:833-362-8789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-03
Last Update Date:2022-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10547152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist