Provider Demographics
NPI:1699923839
Name:YEH, THAO NGUYEN (OD)
Entity type:Individual
Prefix:DR
First Name:THAO
Middle Name:NGUYEN
Last Name:YEH
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 1:2149 OREGON ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1004
Mailing Address - Country:US
Mailing Address - Phone:415-235-1789
Mailing Address - Fax:
Practice Address - Street 1:360 MINOR HALL, MS 2020
Practice Address - Street 2:UC BERKELEY, SCHOOL OF OPTOMETRY, CLINICAL RESEARCH CTR
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-2020
Practice Address - Country:US
Practice Address - Phone:510-642-9649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13588152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist