Basic Information
Provider Information | |||||||||
NPI: | 1639292261 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BUI-PLATTEN | ||||||||
FirstName: | OANH | ||||||||
MiddleName: | KIM | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | O.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BUI | ||||||||
OtherFirstName: | OANH | ||||||||
OtherMiddleName: | KIM | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | O.D | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1950 OLD GALLOWS RD | ||||||||
Address2: | SUITE 520 | ||||||||
City: | VIENNA | ||||||||
State: | VA | ||||||||
PostalCode: | 221823990 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7038478899 | ||||||||
FaxNumber: | 7039910514 | ||||||||
Practice Location | |||||||||
Address1: | 1841 FOUNTAIN DR | ||||||||
Address2: |   | ||||||||
City: | RESTON | ||||||||
State: | VA | ||||||||
PostalCode: | 201903326 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7032642020 | ||||||||
FaxNumber: | 7034819474 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/09/2007 | ||||||||
LastUpdateDate: | 09/23/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 0618001925 | VA | Y |   | Eye and Vision Services Providers | Optometrist |   | 152W00000X | OPT002424 | GA | N |   | Eye and Vision Services Providers | Optometrist |   |
No ID Information.