Provider Demographics
NPI:1194825398
Name:DUONG, DAT (OD)
Entity Type:Individual
Prefix:DR
First Name:DAT
Middle Name:
Last Name:DUONG
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 1:923 ARCH STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:215-925-9830
Mailing Address - Fax:
Practice Address - Street 1:923 ARCH ST FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-2404
Practice Address - Country:US
Practice Address - Phone:215-925-9830
Practice Address - Fax:215-925-0792
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000507152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2119844000OtherKEYSTONE HEALTH PLAN
PA1435485OtherBLUE CHOICE
PA1016458710001Medicaid
PA1850789OtherPERSONAL CHOICE
PA1850789OtherPERSONAL CHOICE
PA1435485OtherBLUE CHOICE