Provider Demographics
NPI:1295474609
Name:BUI, PHUONG-DUYEN
Entity type:Individual
Prefix:
First Name:PHUONG-DUYEN
Middle Name:
Last Name:BUI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4303 HOLLOWSTONE CT
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-2535
Mailing Address - Country:US
Mailing Address - Phone:571-345-5656
Mailing Address - Fax:
Practice Address - Street 1:7702 RICHMOND HWY UNIT H
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-2803
Practice Address - Country:US
Practice Address - Phone:073-770-3717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618003123152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist