MEDICARE: PHUONG-DUYEN BUI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	0618003123	VA

General Provider Information

NPI Number	:	1295474609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHUONG-DUYEN BUI

Provider Business Mailing Address
First Line	:	4303 HOLLOWSTONE CT
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20151-2535
Country	:	US
Telephone Number	:	571-345-5656
Fax Number	:

Provider Business Practice Location Address
First Line	:	7702 RICHMOND HWY UNIT H
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-2803
Country	:	US
Telephone Number	:	73-770-3717
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2022
Last Update Date	:	06/02/2022

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