MEDICARE: PAUL MINH DUC LUONG OD

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	0618003506	VA

General Provider Information

NPI Number	:	1518852227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL MINH DUC LUONG OD

Provider Business Mailing Address
First Line	:	2730 GALLOWS RD APT 636
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22180-7483
Country	:	US
Telephone Number	:	540-836-5131
Fax Number	:

Provider Business Practice Location Address
First Line	:	1340 OLD CHAIN BRIDGE RD STE 102
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22101-3909
Country	:	US
Telephone Number	:	703-893-2020
Fax Number	:

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

Provider Enumeration Date	:	06/11/2025
Last Update Date	:	06/11/2025

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