Healthcare Provider Details

I. General information

NPI: 1679462931
Provider Name (Legal Business Name): SIULLEY VUONG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/01/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

7416 HARWOOD AVE APT 309
WAUWATOSA WI
53213-2644
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number4086-35
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: