Healthcare Provider Details

I. General information

NPI: 1710038583
Provider Name (Legal Business Name): HOLLY TUYET VUONG O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2056 WESTMINSTER MALL
WESTMINSTER CA
92683-4947
US

IV. Provider business mailing address

27665 BLOSSOM HILL RD
LAGUNA NIGUEL CA
92677-6012
US

V. Phone/Fax

Practice location:
  • Phone: 714-897-0996
  • Fax: 714-897-3596
Mailing address:
  • Phone: 949-215-7705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10439T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: