Provider Demographics
NPI:1649210873
Name:THAI, ERIC NHAN GIANG (OD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:NHAN GIANG
Last Name:THAI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11331 OLD HAMMOND HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-8461
Mailing Address - Country:US
Mailing Address - Phone:225-246-8830
Mailing Address - Fax:225-248-6208
Practice Address - Street 1:11331 OLD HAMMOND HWY
Practice Address - Street 2:SUITE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-8461
Practice Address - Country:US
Practice Address - Phone:225-246-8830
Practice Address - Fax:225-248-6208
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS769152W00000X
LA1416-549T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CX17OtherPTAN
LA1741051Medicaid
410000342Medicare ID - Type Unspecified
LA5CX17OtherPTAN