Provider Demographics
NPI:1588835318
Name:DR. PHUONG T. DINH, L.L.C.
Entity Type:Organization
Organization Name:DR. PHUONG T. DINH, L.L.C.
Other - Org Name:VUE EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHUONG
Authorized Official - Middle Name:THANH
Authorized Official - Last Name:DINH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:225-752-2419
Mailing Address - Street 1:2515 O' NEAL LANE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-3309
Mailing Address - Country:US
Mailing Address - Phone:225-752-2419
Mailing Address - Fax:225-752-2420
Practice Address - Street 1:2515 O' NEAL LANE
Practice Address - Street 2:SUITE 5
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3309
Practice Address - Country:US
Practice Address - Phone:225-752-2419
Practice Address - Fax:225-752-2420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1407-550T152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1408981Medicaid
LA5DF07Medicare PIN