Provider Demographics
NPI:1760665202
Name:UC2020 OPTOMETRY
Entity Type:Organization
Organization Name:UC2020 OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHUONG
Authorized Official - Middle Name:HONG
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:562-438-9438
Mailing Address - Street 1:2958 E ANAHEIM ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3726
Mailing Address - Country:US
Mailing Address - Phone:562-438-9438
Mailing Address - Fax:562-438-9430
Practice Address - Street 1:2958 E ANAHEIM ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3726
Practice Address - Country:US
Practice Address - Phone:562-438-9438
Practice Address - Fax:562-438-9430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12080T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD005270Medicaid