Provider Demographics
NPI:1366635831
Name:DO, VINCENT MINH (OD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:MINH
Last Name:DO
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 1:4413 HOFFNER AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-2331
Mailing Address - Country:US
Mailing Address - Phone:407-207-5310
Mailing Address - Fax:407-792-1324
Practice Address - Street 1:4413 HOFFNER AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-2331
Practice Address - Country:US
Practice Address - Phone:407-207-5310
Practice Address - Fax:407-792-1324
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-19
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC#3789152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002289700Medicaid
FLCR748ZMedicare PIN