Provider Demographics
NPI:1346838372
Name:DUONG, PHUONG LAN (OD)
Entity Type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:LAN
Last Name:DUONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1140 EDWARDS VILLAGE BLVD UNIT B206
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-5562
Mailing Address - Country:US
Mailing Address - Phone:970-926-8474
Mailing Address - Fax:
Practice Address - Street 1:1140 EDWARDS VILLAGE BLVD UNIT B206
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-5562
Practice Address - Country:US
Practice Address - Phone:970-926-8474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT0003648152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist