Healthcare Provider Details

I. General information

NPI: 1629418728
Provider Name (Legal Business Name): ANDY YINGJU MU O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2390 W HORIZON RIDGE PKWY STE 100
HENDERSON NV
89052-5084
US

IV. Provider business mailing address

11035 LAVENDER HILL DR STE 160-288
LAS VEGAS NV
89135-2957
US

V. Phone/Fax

Practice location:
  • Phone: 702-825-2085
  • Fax: 702-852-5743
Mailing address:
  • Phone: 702-913-8406
  • Fax: 253-399-8410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number793
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number793
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: