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General NPI Number Information
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NPI Number | 1295474609
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Entity Type | Individual
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Provider Name | PHUONG-DUYEN BUI
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Gender | Female
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Dates
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Enumeration Date | 06/02/2022
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Last Update Date | 06/02/2022
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Provider Practice Location Address
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Address Line | 7702 RICHMOND HWY UNIT H
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City | ALEXANDRIA
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State | VA
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Zip | 22306-2803
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Country | US
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Telephone | 73-770-3717
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Fax |
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Provider Business Mailing Address
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Address Line | 4303 HOLLOWSTONE CT
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City | CHANTILLY
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State | VA
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Zip | 20151-2535
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Country | US
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Telephone | 571-345-5656
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Fax |
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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 | 0618003123
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License Number State | VA
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