Provider Demographics
NPI:1164803094
Name:BUI, DAT (OD)
Entity Type:Individual
Prefix:DR
First Name:DAT
Middle Name:
Last Name:BUI
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 1:1575 B ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-3017
Mailing Address - Country:US
Mailing Address - Phone:510-581-1430
Mailing Address - Fax:510-581-7368
Practice Address - Street 1:1575 B ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-3017
Practice Address - Country:US
Practice Address - Phone:510-581-1430
Practice Address - Fax:510-581-7368
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15227152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA163146Medicare UPIN