Provider Demographics
NPI:1518022466
Name:DUONG, ANH THUY THI (OD)
Entity Type:Individual
Prefix:
First Name:ANH
Middle Name:THUY THI
Last Name:DUONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANH
Other - Middle Name:THUY THI
Other - Last Name:TA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:74 ARCHIPELAGO DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92657-2106
Mailing Address - Country:US
Mailing Address - Phone:949-734-9189
Mailing Address - Fax:
Practice Address - Street 1:2656 W LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2601
Practice Address - Country:US
Practice Address - Phone:714-995-7700
Practice Address - Fax:714-995-0534
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11397152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP11397Medicare ID - Type Unspecified
CAU93254Medicare UPIN