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NPI Code Detail

MEDICARE: DR. VAN LUONG O.D

MEDICARE:  DR. VAN  LUONG  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
1152W00000XOptometristOEG003491PA

General Provider Information

NPI Number : 1699243410
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. VAN LUONG O.D
Provider Business Mailing Address
First Line : 2125 BORBECK AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19152-3713
Country : US
Telephone Number : 267-475-3971
Fax Number :
Provider Business Practice Location Address
First Line : 4423 ROUTE 130 S
Second Line :
City : BURLINGTON
State : NJ
Zip : 08016-2385
Country : US
Telephone Number : 609-386-0202
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2018
Last Update Date : 11/10/2018

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Directions to “ DR. VAN LUONG O.D” Practice Location

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