Provider Demographics
NPI:1376831057
Name:DAWN THANH VU, OD, AN OPTOMETRIC PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DAWN THANH VU, OD, AN OPTOMETRIC PROFESSIONAL CORPORATION
Other - Org Name:ANGELES OPTOMETRIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:THANH
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-357-7950
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:714-547-6070
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-15
Last Update Date:2023-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12373T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFO560AMedicare PIN