Provider Demographics
NPI:1891177895
Name:TA, ANDREW MINH (OD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:MINH
Last Name:TA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9600 VETERANS DR SW BLDG 6
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98493-0003
Mailing Address - Country:US
Mailing Address - Phone:253-583-1250
Mailing Address - Fax:
Practice Address - Street 1:9600 VETERANS DR SW BLDG 6
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493-2223
Practice Address - Country:US
Practice Address - Phone:253-583-1250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-25
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003067152W00000X
WA60709969152W00000X
CA154141TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist