Healthcare Provider Details

I. General information

NPI: 1518974047
Provider Name (Legal Business Name): TRI MINH VUONG O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 W WHEATLAND RD STE A
DALLAS TX
75237-3453
US

IV. Provider business mailing address

9111 CLIFFSIDE DR
CEDAR HILL TX
75104
US

V. Phone/Fax

Practice location:
  • Phone: 972-283-3937
  • Fax:
Mailing address:
  • Phone: 972-283-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5652T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: