Provider Demographics
NPI:1942343918
Name:LAI, HA THAO (OD)
Entity Type:Individual
Prefix:DR
First Name:HA
Middle Name:THAO
Last Name:LAI
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 1:367 JACKLIN RD
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-3225
Mailing Address - Country:US
Mailing Address - Phone:408-946-9393
Mailing Address - Fax:408-946-4406
Practice Address - Street 1:367 JACKLIN RD
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-3225
Practice Address - Country:US
Practice Address - Phone:408-946-9393
Practice Address - Fax:408-946-4406
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10359152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0103590Medicare ID - Type Unspecified
CA56788Medicare UPIN