Provider Demographics
NPI:1932382736
Name:DR. KHANH BUI, O.D., P.C.
Entity Type:Organization
Organization Name:DR. KHANH BUI, O.D., P.C.
Other - Org Name:ENVISION OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:408-223-2020
Mailing Address - Street 1:1013 E CAPITOL EXPY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-2415
Mailing Address - Country:US
Mailing Address - Phone:408-281-1311
Mailing Address - Fax:408-281-1331
Practice Address - Street 1:1013 E CAPITOL EXPY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-2415
Practice Address - Country:US
Practice Address - Phone:408-281-1311
Practice Address - Fax:408-281-1331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD000731Medicaid
CAGSD000731Medicaid