Basic Information
| Provider Information | |||||||||
| NPI: | 1306146154 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DAU | ||||||||
| FirstName: | THANH | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1950 OLD GALLOWS RD | ||||||||
| Address2: | STE 520 | ||||||||
| City: | VIENNA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221823970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038478899 | ||||||||
| FaxNumber: | 7039910514 | ||||||||
| Practice Location | |||||||||
| Address1: | 1250 SCENIC HIGHWAY | ||||||||
| Address2: | STE 1268 | ||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6785120316 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2010 | ||||||||
| LastUpdateDate: | 01/30/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WC0802X | OPT002612 | GA | Y | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management |
No ID Information.