Provider Demographics
NPI:1528042751
Name:VU, VIVIEN VAN (OD)
Entity Type:Individual
Prefix:
First Name:VIVIEN
Middle Name:VAN
Last Name:VU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:VAN
Other - Middle Name:UYEN
Other - Last Name:VU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:17 CHESTERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-7883
Mailing Address - Country:US
Mailing Address - Phone:718-370-1026
Mailing Address - Fax:
Practice Address - Street 1:43 E 167TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-8206
Practice Address - Country:US
Practice Address - Phone:718-992-2128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT006145152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist