Provider Demographics
NPI:1003102724
Name:VINH, JOHN BAO (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BAO
Last Name:VINH
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 1:655 EUCLID AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2973
Mailing Address - Country:US
Mailing Address - Phone:619-472-1010
Mailing Address - Fax:
Practice Address - Street 1:655 EUCLID AVE STE 302
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2973
Practice Address - Country:US
Practice Address - Phone:619-472-1010
Practice Address - Fax:619-544-2184
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14177152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist