MEDICARE: DR. CORY NGUYEN VU O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	10438T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245366897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CORY NGUYEN VU O.D.

Provider Business Mailing Address
First Line	:	1501 CAPITOL AVE STE 71.5144
Second Line	:	P.O. BOX 997413, MS 4600
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-5005
Country	:	US
Telephone Number	:	916-552-9539
Fax Number	:	916-440-5640

Provider Business Practice Location Address
First Line	:	1501 CAPITOL AVE STE 71.5144
Second Line	:	MS 4600
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-5005
Country	:	US
Telephone Number	:	916-552-9539
Fax Number	:	916-440-5640

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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