Basic Information
Provider Information
NPI: 1730136904
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BUI
FirstName: VIET
MiddleName: NGOC
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2020 FLEISCHMANN RD
Address2:  
City: TALLAHASSEE
State: FL
PostalCode: 323084599
CountryCode: US
TelephoneNumber: 8508786161
FaxNumber:  
Practice Location
Address1: 2020 FLEISCHMANN RD
Address2:  
City: TALLAHASSEE
State: FL
PostalCode: 323084599
CountryCode: US
TelephoneNumber: 8508786161
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/31/2006
LastUpdateDate: 05/31/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/31/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207W00000XME104798FLY Allopathic & Osteopathic PhysiciansOphthalmology 

No ID Information.


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