Provider Demographics
NPI:1457505505
Name:AMY THI VU OD INC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:AMY THI VU OD INC A PROFESSIONAL CORPORATION
Other - Org Name:ALISO NIGUEL OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:T
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:949-448-7464
Mailing Address - Street 1:27270 ALICIA PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-3413
Mailing Address - Country:US
Mailing Address - Phone:949-448-7464
Mailing Address - Fax:949-448-7469
Practice Address - Street 1:27270 ALICIA PKWY STE D
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-3413
Practice Address - Country:US
Practice Address - Phone:949-448-7464
Practice Address - Fax:949-448-7469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT12383T305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABD348Medicare PIN