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General NPI Number Information
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NPI Number | 1053552083
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Entity Type | Organization
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Legal Business Name | UC2020 OPTOMETRY PC
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Dates
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Enumeration Date | 03/21/2009
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Last Update Date | 05/15/2009
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Provider Practice Location Address
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Address Line | 3000 E ANAHEIM ST
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City | LONG BEACH
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State | CA
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Zip | 90804-3802
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Country | US
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Telephone | 562-438-9438
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Fax | 562-438-9430
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Provider Business Mailing Address
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Address Line | 3000 E ANAHEIM ST
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City | LONG BEACH
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State | CA
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Zip | 90804-3802
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Country | US
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Telephone | 562-438-9438
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Fax | 562-438-9430
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Authorized Official
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Title or Position | PRESIDENT
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Name | PHUONG HONG VU
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Credential | O.D.
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Telephone | 562-438-9438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 12080T
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License Number State | CA
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