Provider Demographics
NPI:1568513521
Name:VU, THAO PHOUNG (OD)
Entity Type:Individual
Prefix:
First Name:THAO
Middle Name:PHOUNG
Last Name:VU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1321 N HARBOR BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4125
Mailing Address - Country:US
Mailing Address - Phone:714-871-2570
Mailing Address - Fax:714-526-2020
Practice Address - Street 1:1321 N HARBOR BLVD
Practice Address - Street 2:STE 300
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4125
Practice Address - Country:US
Practice Address - Phone:714-871-2570
Practice Address - Fax:714-526-2020
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA12671T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0126710Medicare PIN
CAV01167Medicare UPIN