Provider Demographics
NPI:1750636163
Name:MAI, THANH VU (OD)
Entity Type:Individual
Prefix:DR
First Name:THANH
Middle Name:VU
Last Name:MAI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3151 AIRWAY AVE
Mailing Address - Street 2:STE J2
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4624
Mailing Address - Country:US
Mailing Address - Phone:714-486-3315
Mailing Address - Fax:714-486-3071
Practice Address - Street 1:3151 AIRWAY AVE
Practice Address - Street 2:STE J2
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4624
Practice Address - Country:US
Practice Address - Phone:714-486-3315
Practice Address - Fax:714-486-3071
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2018-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAOPT 14402 TLG152WC0802X, 152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy