Provider Demographics
NPI:1952473035
Name:LUONG, DINH (OD)
Entity Type:Individual
Prefix:
First Name:DINH
Middle Name:
Last Name:LUONG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 MCCOMAS WAY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456
Mailing Address - Country:US
Mailing Address - Phone:757-301-8847
Mailing Address - Fax:757-301-8853
Practice Address - Street 1:2105 MCCOMAS WAY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456
Practice Address - Country:US
Practice Address - Phone:757-301-8847
Practice Address - Fax:757-301-8853
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2012-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001177152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00993024OtherRAILROAD MEDICARE