Healthcare Provider Details

I. General information

NPI: 1851600407
Provider Name (Legal Business Name): MY-HANH VU O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANH VU O.D.

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 08/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 AVENUE OF THE AMERICAS STE 205
NEW YORK NY
10001-3514
US

IV. Provider business mailing address

901 AVENUE OF THE AMERICAS STE 205
NEW YORK NY
10001-3514
US

V. Phone/Fax

Practice location:
  • Phone: 212-967-4177
  • Fax: 212-967-2101
Mailing address:
  • Phone: 212-967-4177
  • Fax: 212-967-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00626700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV007598-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: