Provider Demographics
NPI:1023190089
Name:BUI, DUC MINH
Entity Type:Individual
Prefix:DR
First Name:DUC
Middle Name:MINH
Last Name:BUI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4095 EVERGREEN VILLAGE SQ STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1747
Mailing Address - Country:US
Mailing Address - Phone:408-532-1308
Mailing Address - Fax:
Practice Address - Street 1:4095 EVERGREEN VILLAGE SQ STE 110
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95135-1747
Practice Address - Country:US
Practice Address - Phone:408-532-1308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11044T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist