Provider Demographics
NPI:1235330200
Name:BUI, KIM-QUYEN THI (OD)
Entity Type:Individual
Prefix:
First Name:KIM-QUYEN
Middle Name:THI
Last Name:BUI
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 1:7613 NORTHINGTON CT
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-4856
Mailing Address - Country:US
Mailing Address - Phone:703-266-9099
Mailing Address - Fax:
Practice Address - Street 1:14637 LEE HIGHWAY
Practice Address - Street 2:SUITE 104
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-5830
Practice Address - Country:US
Practice Address - Phone:703-266-9099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist