Provider Demographics
NPI:1245457852
Name:TAN D. VU OD, INC
Entity type:Organization
Organization Name:TAN D. VU OD, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAN
Authorized Official - Middle Name:DUY
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:951-678-7690
Mailing Address - Street 1:34859 FREDRICK STREET
Mailing Address - Street 2:SUITE 109
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-2595
Mailing Address - Country:US
Mailing Address - Phone:951-678-7690
Mailing Address - Fax:951-837-4816
Practice Address - Street 1:34859 FREDRICK STREET
Practice Address - Street 2:SUITE 109
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-2595
Practice Address - Country:US
Practice Address - Phone:951-678-7690
Practice Address - Fax:951-837-4816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12670T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0126700Medicaid
CASD0126700Medicaid
CAV07043Medicare UPIN