MEDICARE: UC2020 OPTOMETRY

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	12080T	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	:	1760665202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UC2020 OPTOMETRY

Provider Business Mailing Address
First Line	:	2958 E ANAHEIM ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-3726
Country	:	US
Telephone Number	:	562-438-9438
Fax Number	:	562-438-9430

Provider Business Practice Location Address
First Line	:	2958 E ANAHEIM ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-3726
Country	:	US
Telephone Number	:	562-438-9438
Fax Number	:	562-438-9430

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PHUONG HONG VU
Credential	:	O.D.
Telephone Number	:	562-438-9438

Provider Enumeration Date	:	12/06/2007
Last Update Date	:	12/06/2007

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Directions to “UC2020 OPTOMETRY ” Practice Location

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