Healthcare Provider Details

I. General information

NPI: 1649504523
Provider Name (Legal Business Name): LAUREL VUONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST PRATT OPHTHALMOLOGY ASSOCIATES, INC
BOSTON MA
02111-1552
US

IV. Provider business mailing address

800 WASHINGTON ST PRATT OPHTHALMOLOGY ASSOCIATES, INC
BOSTON MA
02111-1552
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-5000
  • Fax:
Mailing address:
  • Phone: 617-636-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number069998
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: