Provider Demographics
NPI:1396739041
Name:TA, SEAN NHAN (OD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:NHAN
Last Name:TA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:NHAN
Other - Middle Name:THANH
Other - Last Name:TA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2410 HAVENCREST CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-1552
Mailing Address - Country:US
Mailing Address - Phone:281-935-3373
Mailing Address - Fax:
Practice Address - Street 1:1710 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5604
Practice Address - Country:US
Practice Address - Phone:281-648-2269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6299TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU99816Medicare UPIN