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General NPI Number Information
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NPI Number | 1992155923
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Entity Type | Individual
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Provider Name | PAUL DUY LUONG OD
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Gender | Male
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Dates
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Enumeration Date | 06/21/2016
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Last Update Date | 12/10/2019
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Provider Practice Location Address
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Address Line | 9890 CLAYTON RD SUITE 200
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City | SAINT LOUIS
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State | MO
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Zip | 63124-1685
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Country | US
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Telephone | 314-395-9613
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Fax |
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Provider Business Mailing Address
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Address Line | 9890 CLAYTON RD SUITE 200
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City | SAINT LOUIS
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State | MO
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Zip | 63124-1685
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Country | US
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Telephone | 314-395-9613
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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 | 2016017804
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License Number State | MO
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