Provider Demographics
NPI:1255523189
Name:VU, PHONG QUOC (OD)
Entity type:Individual
Prefix:
First Name:PHONG
Middle Name:QUOC
Last Name:VU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 TRANCAS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3044
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 TRANCAS ST
Practice Address - Street 2:SUITE A
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3044
Practice Address - Country:US
Practice Address - Phone:707-255-6212
Practice Address - Fax:707-255-6290
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13356152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist