Provider Demographics
NPI:1669909701
Name:NIM, VUON LAY (OD)
Entity type:Individual
Prefix:DR
First Name:VUON
Middle Name:LAY
Last Name:NIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3940 BUFORD HWY STE A104
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8212
Mailing Address - Country:US
Mailing Address - Phone:470-440-4099
Mailing Address - Fax:470-588-8894
Practice Address - Street 1:3940 BUFORD HWY STE A104
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8212
Practice Address - Country:US
Practice Address - Phone:470-440-4099
Practice Address - Fax:470-588-8894
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-19
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003030152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometrist