Healthcare Provider Details

I. General information

NPI: 1982032959
Provider Name (Legal Business Name): THUYVAN VO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 MAPLEWOOD AVE
WINSTON SALEM NC
27103-3906
US

IV. Provider business mailing address

411 HARVEST PINE RD
LEWISVILLE NC
27023-9696
US

V. Phone/Fax

Practice location:
  • Phone: 336-765-8130
  • Fax:
Mailing address:
  • Phone: 832-651-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2330
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2330
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2330
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerLICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: