Healthcare Provider Details

I. General information

NPI: 1750730925
Provider Name (Legal Business Name): VICTOR CHI VUONG O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 WOLF RD STE 106
ALBANY NY
12205-2621
US

IV. Provider business mailing address

65 WOLF RD STE 106
ALBANY NY
12205-2621
US

V. Phone/Fax

Practice location:
  • Phone: 518-463-1707
  • Fax: 518-949-2499
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV008404-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: