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General NPI Number Information
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NPI Number | 1245457852
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Entity Type | Organization
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Legal Business Name | TAN D. VU OD, INC
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 07/08/2011
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Provider Practice Location Address
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Address Line | 34859 FREDRICK STREET SUITE 109
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City | WILDOMAR
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State | CA
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Zip | 92595-2595
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Country | US
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Telephone | 951-678-7690
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Fax | 951-837-4816
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Provider Business Mailing Address
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Address Line | 34859 FREDRICK STREET SUITE 109
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City | WILDOMAR
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State | CA
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Zip | 92595-2595
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Country | US
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Telephone | 951-678-7690
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Fax | 951-837-4816
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TAN DUY VU
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Credential | O.D.
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Telephone | 951-678-7690
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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 | 12670T
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License Number State | CA
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