Healthcare Provider Details

I. General information

NPI: 1710723630
Provider Name (Legal Business Name): BAO CHAU TRINH VU OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 S MAIN ST STE 325
ORANGE CA
92868-3818
US

IV. Provider business mailing address

6 MARYSVILLE
IRVINE CA
92602-1065
US

V. Phone/Fax

Practice location:
  • Phone: 888-501-4496
  • Fax:
Mailing address:
  • Phone: 714-653-0731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT35727-TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: