Healthcare Provider Details

I. General information

NPI: 1750526224
Provider Name (Legal Business Name): REBECCA BUI VAN O D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4005 MANZANITA AVE STE 57
CARMICHAEL CA
95608-1784
US

IV. Provider business mailing address

4005 MANZANITA AVE STE 57
CARMICHAEL CA
95608-1784
US

V. Phone/Fax

Practice location:
  • Phone: 916-483-6661
  • Fax: 916-514-8637
Mailing address:
  • Phone: 916-483-6661
  • Fax: 916-514-8637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number112098T
License Number StateCA

VIII. Authorized Official

Name: REBECCA BUI VAN
Title or Position: DOCTOR
Credential: OD
Phone: 916-483-6661