Provider Demographics
NPI:1679581094
Name:VU, QUYNH T
Entity type:Individual
Prefix:
First Name:QUYNH
Middle Name:T
Last Name:VU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:QUYNH-NHU
Other - Middle Name:TERESA
Other - Last Name:VU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:18285 COLLIER AVE STE 1F
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-2786
Mailing Address - Country:US
Mailing Address - Phone:951-674-5057
Mailing Address - Fax:951-674-4392
Practice Address - Street 1:18285 COLLIER AVE STE 1F
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-2786
Practice Address - Country:US
Practice Address - Phone:951-674-5057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11497T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0114970Medicaid