Provider Demographics
NPI:1225410244
Name:VI, CHAU NGOC (OD)
Entity Type:Individual
Prefix:
First Name:CHAU
Middle Name:NGOC
Last Name:VI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10120 S EASTERN AVE
Mailing Address - Street 2:SUITE 165
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3951
Mailing Address - Country:US
Mailing Address - Phone:702-456-9585
Mailing Address - Fax:702-456-0011
Practice Address - Street 1:14079 FM 2920 RD
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-5546
Practice Address - Country:US
Practice Address - Phone:281-500-9606
Practice Address - Fax:281-421-7836
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9249T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX592634YKVCOtherMEDICARE ID
TX375495401Medicaid