=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881171999
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NHUY THI VO OD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2018
-----------------------------------------------------
Last Update Date | 07/21/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3333 BUFORD DR STE 2002
-----------------------------------------------------
City | BUFORD
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30519-4935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-482-4585
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1221 HAMPTON HILL CT
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30044-2586
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-709-8549
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPT003112
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------