Provider Demographics
NPI:1659345874
Name:BUI, DYLAN H (OD)
Entity Type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:H
Last Name:BUI
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 1:216 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-5526
Mailing Address - Country:US
Mailing Address - Phone:781-321-8883
Mailing Address - Fax:781-321-8882
Practice Address - Street 1:216 CENTRE ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5526
Practice Address - Country:US
Practice Address - Phone:781-321-8883
Practice Address - Fax:781-321-8882
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4404152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW17550Medicare ID - Type Unspecified