Provider Demographics
NPI:1710038583
Name:VUONG, HOLLY TUYET (OD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:TUYET
Last Name:VUONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27665 BLOSSOM HILL RD
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-6012
Mailing Address - Country:US
Mailing Address - Phone:949-215-7705
Mailing Address - Fax:
Practice Address - Street 1:2056 WESTMINSTER MALL
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4947
Practice Address - Country:US
Practice Address - Phone:714-897-0996
Practice Address - Fax:714-897-3596
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10439T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP10439Medicare ID - Type Unspecified