Provider Demographics
NPI:1831242288
Name:VU, AMY THI (OD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:THI
Last Name:VU
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 1:27270 ALICIA PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-3413
Mailing Address - Country:US
Mailing Address - Phone:949-448-7464
Mailing Address - Fax:949-448-7469
Practice Address - Street 1:27270 ALICIA PKWY STE D
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-3413
Practice Address - Country:US
Practice Address - Phone:949-448-7464
Practice Address - Fax:949-448-7469
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12383152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABD349ZMedicare PIN