Provider Demographics
NPI:1255325296
Name:VU, DAWN THANH (OD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:THANH
Last Name:VU
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 1:700 W 1ST ST STE 1
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2948
Mailing Address - Country:US
Mailing Address - Phone:714-547-6819
Mailing Address - Fax:661-273-4545
Practice Address - Street 1:700 W 1ST ST STE 1
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2948
Practice Address - Country:US
Practice Address - Phone:714-547-6819
Practice Address - Fax:714-547-6070
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2023-01-15
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-18
Provider Licenses
StateLicense IDTaxonomies
CA12373T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD012373Medicaid
CAFO584ZMedicare PIN
CASD0123730Medicare ID - Type Unspecified
CASD012373Medicaid