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Individual

CHUATONG THAO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
11651 FOUNTAINS DR STE A-104, MAPLE GROVE, MN 55369-7195
(763) 315-1149
Mailing address
11900 NEVADA AVE N, CHAMPLIN, MN 55316-2217

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3526
MN

Other

Enumeration date
07/06/2017
Last updated
07/06/2017
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