Provider Demographics
NPI:1972816866
Name:KHUAT, DUNG (OD)
Entity type:Individual
Prefix:DR
First Name:DUNG
Middle Name:
Last Name:KHUAT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:JOE
Other - Middle Name:
Other - Last Name:KHUAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:6021 WALKER BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-0904
Mailing Address - Country:US
Mailing Address - Phone:682-235-8285
Mailing Address - Fax:682-235-8285
Practice Address - Street 1:6021 WALKER BLVD STE 111
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-0904
Practice Address - Country:US
Practice Address - Phone:682-235-8285
Practice Address - Fax:682-235-8285
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7603TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB109465Medicare PIN