Provider Demographics
NPI:1104014455
Name:KELLY, TINA VU (OD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:VU
Last Name:KELLY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:TINA
Other - Middle Name:TUONG-NHU
Other - Last Name:VU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3223 DUKE ST STE B3
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4555
Mailing Address - Country:US
Mailing Address - Phone:703-813-8997
Mailing Address - Fax:
Practice Address - Street 1:3223 DUKE ST
Practice Address - Street 2:SUITE B3
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4586
Practice Address - Country:US
Practice Address - Phone:703-813-8997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001670152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist