Healthcare Provider Details

I. General information

NPI: 1689661571
Provider Name (Legal Business Name): RICHARD N.V. PHUNG O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9880 HIBERT ST SUITE E-1
SAN DIEGO CA
92131-1068
US

IV. Provider business mailing address

9880 HIBERT ST SUITE E-1
SAN DIEGO CA
92131-1068
US

V. Phone/Fax

Practice location:
  • Phone: 858-693-9044
  • Fax: 858-693-0704
Mailing address:
  • Phone: 858-693-9044
  • Fax: 858-693-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number9547T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: