Provider Demographics
NPI:1750375580
Name:VAN, DA-THUY T (DO)
Entity type:Individual
Prefix:DR
First Name:DA-THUY
Middle Name:T
Last Name:VAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:7155 OLD KATY RD
Mailing Address - Street 2:N100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2134
Mailing Address - Country:US
Mailing Address - Phone:713-668-6828
Mailing Address - Fax:832-280-3636
Practice Address - Street 1:2302 AVENUE P
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-7932
Practice Address - Country:US
Practice Address - Phone:409-765-6324
Practice Address - Fax:409-765-8475
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2022-12-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL2723207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00308354OtherRR MEDICARE
TX147156702Medicaid
TX7586253OtherAETNA PROVIDER NUMBER
TX8V5050OtherBLUE CROSS BLUE SHIELD
TXH43603Medicare UPIN
TX7586253OtherAETNA PROVIDER NUMBER