Provider Demographics
NPI:1740495183
Name:BUU, THI DONG (OD)
Entity type:Individual
Prefix:DR
First Name:THI
Middle Name:DONG
Last Name:BUU
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:25321 RAILROAD CANYON ROAD
Mailing Address - Street 2:SUITE 503
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532-2702
Mailing Address - Country:US
Mailing Address - Phone:951-244-1122
Mailing Address - Fax:951-244-2777
Practice Address - Street 1:25321 RAILROAD CANYON RD
Practice Address - Street 2:SUITE 503
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92532-2702
Practice Address - Country:US
Practice Address - Phone:951-244-1122
Practice Address - Fax:951-244-2777
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA11411T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACC273YMedicare PIN