Provider Demographics
NPI:1215369236
Name:DUONG, KEVIN MINH (OD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MINH
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 1:10000 DAWNADELE AVE
Mailing Address - Street 2:BUILDING A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2591
Mailing Address - Country:US
Mailing Address - Phone:225-295-4615
Mailing Address - Fax:225-295-4616
Practice Address - Street 1:10000 DAWNADELE AVE
Practice Address - Street 2:BUILDING A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2591
Practice Address - Country:US
Practice Address - Phone:225-288-0149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1657-691T152WC0802X, 152WL0500X, 152WS0006X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision