Provider Demographics
NPI:1235206202
Name:VO, KIM UYEN (OD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:UYEN
Last Name:VO
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 1:925 PHEASANT RUN CIR
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:IN
Mailing Address - Zip Code:46304-1393
Mailing Address - Country:US
Mailing Address - Phone:219-395-8147
Mailing Address - Fax:
Practice Address - Street 1:3134 E 79TH AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5738
Practice Address - Country:US
Practice Address - Phone:219-942-4973
Practice Address - Fax:219-942-1803
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003158A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist