Active NPI
Chuatong Thao, OD
- Optometrist
- Maple Grove, MN
National Provider Identifier
1609397116
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 3526
- Practice address
- 11651 Fountains Dr Ste a-104
Maple Grove, MN 55369-7195 - Phone
- (763) 315-1149
- NPI assigned
- Jul 6, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3526 | MN | Primary |
Addresses
Primary practice location
11651 Fountains Dr Ste a-104
Maple Grove, MN 55369-7195
Mailing address
11900 Nevada Ave N
Champlin, MN 55316-2217
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3526 | MN | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| America'S Best Contacts & Eyeglasses | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Optician
- Maple Grove, MN
- NPI 1851696496
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1499299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1499299200000",
"number": "1609397116",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11900 NEVADA AVE N",
"city": "CHAMPLIN",
"state": "MN",
"postal_code": "553162217"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11651 FOUNTAINS DR STE A-104",
"city": "MAPLE GROVE",
"state": "MN",
"postal_code": "553697195",
"telephone_number": "763-315-1149"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THAO",
"first_name": "CHUATONG",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-07-06",
"last_updated": "2017-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "3526",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maple Grove, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.