Basic Information
| Provider Information | |||||||||
| NPI: | 1114282373 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DINH | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | THANH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2525 LUCAS DRIVE | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2145287948 | ||||||||
| FaxNumber: | 2145287387 | ||||||||
| Practice Location | |||||||||
| Address1: | 2525 LUCAS DRIVE | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2145287948 | ||||||||
| FaxNumber: | 2145287387 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2012 | ||||||||
| LastUpdateDate: | 09/12/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 7990T | TX | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 7990TG | TX | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 112409105 | 05 | TX | MEDICAID | 1124091-04 | 05 | TX | MEDICAID |