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General NPI Number Information
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NPI Number | 1245366897
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Entity Type | Individual
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Provider Name | CORY NGUYEN VU O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1501 CAPITOL AVE STE 71.5144 MS 4600
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City | SACRAMENTO
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State | CA
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Zip | 95814-5005
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Country | US
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Telephone | 916-552-9539
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Fax | 916-440-5640
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Provider Business Mailing Address
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Address Line | 1501 CAPITOL AVE STE 71.5144 P.O. BOX 997413, MS 4600
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City | SACRAMENTO
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State | CA
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Zip | 95814-5005
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Country | US
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Telephone | 916-552-9539
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Fax | 916-440-5640
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 10438T
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License Number State | CA
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