MEDICARE: UYENTHU VO 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	OPT003242	GA

General Provider Information

NPI Number	:	1609484773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	UYENTHU VO OD

Provider Business Mailing Address
First Line	:	4437 BOATMANS CV
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30083-2483
Country	:	US
Telephone Number	:	770-789-7904
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 MARKETPLACE BLVD
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-8129
Country	:	US
Telephone Number	:	404-346-2020
Fax Number	:

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

Provider Enumeration Date	:	07/15/2020
Last Update Date	:	07/15/2020

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Directions to “ UYENTHU VO OD” Practice Location

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