Provider Demographics
NPI:1881017705
Name:XU, VIVIEN JINGYI (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:VIVIEN
Middle Name:JINGYI
Last Name:XU
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6507 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-3703
Mailing Address - Country:US
Mailing Address - Phone:718-708-5525
Mailing Address - Fax:718-708-5927
Practice Address - Street 1:6507 18TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3703
Practice Address - Country:US
Practice Address - Phone:718-708-5525
Practice Address - Fax:718-708-5927
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC009422156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician