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General NPI Number Information
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NPI Number | 1740495183
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Entity Type | Individual
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Provider Name | THI DONG BUU O.D.
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Gender | Female
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 04/19/2011
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Provider Practice Location Address
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Address Line | 25321 RAILROAD CANYON RD SUITE 503
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City | LAKE ELSINORE
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State | CA
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Zip | 92532-2702
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Country | US
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Telephone | 951-244-1122
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Fax | 951-244-2777
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Provider Business Mailing Address
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Address Line | 25321 RAILROAD CANYON ROAD SUITE 503
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City | LAKE ELSINORE
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State | CA
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Zip | 92532-2702
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Country | US
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Telephone | 951-244-1122
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Fax | 951-244-2777
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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 | 11411T
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License Number State | CA
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