Healthcare Provider Details

I. General information

NPI: 1710188784
Provider Name (Legal Business Name): QUYNH LYNN VU O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LYNN QUYNH VU O.D.

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 05/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3213 ROBERT DR
RICHARDSON TX
75082-3778
US

IV. Provider business mailing address

3716 CANTERA LN
RICHARDSON TX
75082-2772
US

V. Phone/Fax

Practice location:
  • Phone: 214-734-9791
  • Fax: 972-235-6584
Mailing address:
  • Phone: 214-734-9791
  • Fax: 972-422-5329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number5759TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: