Provider Demographics
NPI:1104239151
Name:TANEHSAKDI, MORAKOT (OD)
Entity type:Individual
Prefix:DR
First Name:MORAKOT
Middle Name:
Last Name:TANEHSAKDI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:U CHU LIANG BLD 6TH FL, 968 RAMA IV ROAD
Mailing Address - Street 2:SILOM, BANGRAK
Mailing Address - City:BANGKOK
Mailing Address - State:SILOM
Mailing Address - Zip Code:10500
Mailing Address - Country:TH
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:U CHU LIANG BLD 6TH FL, 968 RAMA IV ROAD
Practice Address - Street 2:SILOM, BANGRAK
Practice Address - City:BANGKOK
Practice Address - State:SILOM
Practice Address - Zip Code:10500
Practice Address - Country:TH
Practice Address - Phone:662-732-4431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-07
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12650152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist