Provider Demographics
NPI:1669584397
Name:MAI, THAO PHUONG (OD)
Entity type:Individual
Prefix:MISS
First Name:THAO
Middle Name:PHUONG
Last Name:MAI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:96 WESTPARK CT
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-4998
Mailing Address - Country:US
Mailing Address - Phone:504-723-3546
Mailing Address - Fax:
Practice Address - Street 1:4810 LAPALCO BLVD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-4326
Practice Address - Country:US
Practice Address - Phone:504-341-0818
Practice Address - Fax:504-341-0567
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1530-568T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist