Provider Demographics
NPI:1326713793
Name:VUONG, DEREK (OD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:VUONG
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 1:11103 ROCKAWAY ST
Mailing Address - Street 2:
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-5226
Mailing Address - Country:US
Mailing Address - Phone:626-525-3016
Mailing Address - Fax:
Practice Address - Street 1:820 ROUTE 9 STE 1308
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-1749
Practice Address - Country:US
Practice Address - Phone:518-745-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009434152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist