Healthcare Provider Details

I. General information

NPI: 1588835318
Provider Name (Legal Business Name): DR. PHUONG T. DINH, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 O' NEAL LANE SUITE 5
BATON ROUGE LA
70816-3309
US

IV. Provider business mailing address

2515 O' NEAL LANE SUITE 5
BATON ROUGE LA
70816-3309
US

V. Phone/Fax

Practice location:
  • Phone: 225-752-2419
  • Fax: 225-752-2420
Mailing address:
  • Phone: 225-752-2419
  • Fax: 225-752-2420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1407-550T
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number1407-550T
License Number StateLA

VIII. Authorized Official

Name: DR. PHUONG THANH DINH
Title or Position: OWNER
Credential: O.D.
Phone: 225-752-2419