Basic Information
Provider Information | |||||||||
NPI: | 1285755280 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | VU | ||||||||
FirstName: | DANNY | ||||||||
MiddleName: | DUY | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | O.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | VU | ||||||||
OtherFirstName: | DANNY | ||||||||
OtherMiddleName: | DUY | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | O.D. | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 1528 HIGHPOINT ST | ||||||||
Address2: |   | ||||||||
City: | UPLAND | ||||||||
State: | CA | ||||||||
PostalCode: | 917848613 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9095598977 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1540 W FOOTHILL BLVD | ||||||||
Address2: |   | ||||||||
City: | UPLAND | ||||||||
State: | CA | ||||||||
PostalCode: | 917863653 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9099817634 | ||||||||
FaxNumber: | 9099857497 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/03/2007 | ||||||||
LastUpdateDate: | 08/29/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 11443 | CA | Y |   | Eye and Vision Services Providers | Optometrist |   |
No ID Information.