Provider Demographics
NPI:1922174804
Name:DINH, PHUONG THANH (OD)
Entity Type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:THANH
Last Name:DINH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 O' NEAL LANE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-3309
Mailing Address - Country:US
Mailing Address - Phone:225-752-2419
Mailing Address - Fax:225-752-2420
Practice Address - Street 1:2515 O' NEAL LANE
Practice Address - Street 2:SUITE 5
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3309
Practice Address - Country:US
Practice Address - Phone:225-752-2419
Practice Address - Fax:225-752-2420
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1407-550T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1408981Medicaid
LA1408981Medicaid