1720259070 NPI number — DR. AMY T. DINH, LLC

Table of content: (NPI 1720259070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720259070 NPI number — DR. AMY T. DINH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. AMY T. DINH, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
IDEAL VISION CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720259070
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9828 BLUEBONNET BLVD STE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70810-6461
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-766-8788
Provider Business Mailing Address Fax Number:
225-766-8003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9828 BLUEBONNET BLVD STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70810-6461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-766-8788
Provider Business Practice Location Address Fax Number:
225-766-8003
Provider Enumeration Date:
03/14/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DINH
Authorized Official First Name:
AMY
Authorized Official Middle Name:
THANH
Authorized Official Title or Position:
OPTOMETRIST/ OWNER
Authorized Official Telephone Number:
225-766-8788

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1406-544T , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332H00000X , with the licence number: 1406-544T , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)