MEDICARE: DR. VANCE WEN FA KU OD

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	9655TG	TX

General Provider Information

NPI Number	:	1568026185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANCE WEN FA KU OD

Provider Business Mailing Address
First Line	:	5615 RIVERSTONE CROSSING DR
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-4869
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5615 RIVERSTONE CROSSING DR
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-4869
Country	:	US
Telephone Number	:	303-907-8781
Fax Number	:

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

Provider Enumeration Date	:	04/29/2019
Last Update Date	:	01/22/2022

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