Provider Demographics
NPI:1437714490
Name:VU, LONG VAN (OD)
Entity Type:Individual
Prefix:
First Name:LONG
Middle Name:VAN
Last Name:VU
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 1:7510 HAYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77061-1508
Mailing Address - Country:US
Mailing Address - Phone:832-771-0537
Mailing Address - Fax:
Practice Address - Street 1:2506 25TH AVE N STE 3
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77590-4666
Practice Address - Country:US
Practice Address - Phone:409-945-5511
Practice Address - Fax:409-945-5385
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9740T152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy