Provider Demographics
NPI:1962604843
Name:TIEU, ANH M (OD)
Entity type:Individual
Prefix:DR
First Name:ANH
Middle Name:M
Last Name:TIEU
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 1:430 E CANYON WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-3094
Mailing Address - Country:US
Mailing Address - Phone:480-234-5787
Mailing Address - Fax:480-366-3964
Practice Address - Street 1:2887 S MARKET ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-6303
Practice Address - Country:US
Practice Address - Phone:480-366-3963
Practice Address - Fax:480-366-3964
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1373152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZVO1347Medicare UPIN