Provider Demographics
NPI:1336349570
Name:VP OPTOMETRIC, INC.
Entity Type:Organization
Organization Name:VP OPTOMETRIC, INC.
Other - Org Name:LANDESS OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:QUAN
Authorized Official - Middle Name:LONG
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:408-945-0200
Mailing Address - Street 1:1553 LANDESS AVE
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-6901
Mailing Address - Country:US
Mailing Address - Phone:408-945-0200
Mailing Address - Fax:408-945-4200
Practice Address - Street 1:1553 LANDESS AVE
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-6901
Practice Address - Country:US
Practice Address - Phone:408-945-0200
Practice Address - Fax:408-945-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12147T305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service