Provider Demographics
NPI:1518616473
Name:VO, BRIAN PHU (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PHU
Last Name:VO
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 1:4731 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-2693
Mailing Address - Country:US
Mailing Address - Phone:817-791-4654
Mailing Address - Fax:
Practice Address - Street 1:8740 MONTGOMERY RD STE 106
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2152
Practice Address - Country:US
Practice Address - Phone:513-791-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-19
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OHOPT.007098152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program