Provider Demographics
NPI:1447389366
Name:VU, LONG D
Entity Type:Individual
Prefix:
First Name:LONG
Middle Name:D
Last Name:VU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410-1 FAIR OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-4017
Mailing Address - Country:US
Mailing Address - Phone:916-484-1080
Mailing Address - Fax:916-484-0604
Practice Address - Street 1:6410-1 FAIR OAKS BLVD
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-4017
Practice Address - Country:US
Practice Address - Phone:916-484-1080
Practice Address - Fax:916-484-0604
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADX4002156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0185060001Medicare ID - Type Unspecified