Basic Information
| Provider Information | |||||||||
| NPI: | 1336404342 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HO | ||||||||
| FirstName: | THANH THAO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1922 GREYSTONE TRL | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328184784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072303663 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3968 SW ARCHER RD # W101 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326082342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523766622 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2012 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 152W00000X | OPC 4748 | FL | Y | Eye and Vision Services Providers | Optometrist | 152W00000X | OEG002634 | PA | N | Eye and Vision Services Providers | Optometrist |
No ID Information.