Basic Information
| Provider Information | |||||||||
| NPI: | 1306092317 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KHA | ||||||||
| FirstName: | THU HOA | ||||||||
| MiddleName: | THI | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KHA | ||||||||
| OtherFirstName: | THU | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | O.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 15129 SHELLWOOD LN | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750356493 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | |||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2401 S STEMMONS FWY | ||||||||
| Address2: | SUITE 2214 | ||||||||
| City: | LEWISVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750678775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724594908 | ||||||||
| FaxNumber: | 9723155126 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2008 | ||||||||
| LastUpdateDate: | 08/10/2008 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 7259T | TX | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.