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General NPI Number Information
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NPI Number | 1700067097
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Entity Type | Organization
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Legal Business Name | MY M. VUONG, O.D.
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 6464 N DECATUR BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89131-2959
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Country | US
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Telephone | 702-433-2010
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Fax |
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Provider Business Mailing Address
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Address Line | 6512 N DECATUR BLVD STE 130-234
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City | LAS VEGAS
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State | NV
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Zip | 89131-1046
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Country | US
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Telephone | 702-433-2010
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MY MY VUONG
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Credential | O.D.
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Telephone | 949-295-5640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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