Healthcare Provider Details

I. General information

NPI: 1578770525
Provider Name (Legal Business Name): MY-HANH TRIEU OD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6015A WILSON BLVD
ARLINGTON VA
22205-1503
US

IV. Provider business mailing address

6015A WILSON BLVD
ARLINGTON VA
22205-1503
US

V. Phone/Fax

Practice location:
  • Phone: 703-534-8801
  • Fax: 703-534-8803
Mailing address:
  • Phone: 703-534-8801
  • Fax: 703-534-8803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. MY-HANH TRIEU
Title or Position: PRESIDENT
Credential: O.D.
Phone: 703-534-8801