Basic Information
| Provider Information | |||||||||
| NPI: | 1871871657 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | XIN | ||||||||
| FirstName: | DUYEN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3750 GUNN HWY STE 108 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336188911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137120660 | ||||||||
| FaxNumber: | 8133157900 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 E BROADWAY | ||||||||
| Address2: | |||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184629818 | ||||||||
| FaxNumber: | 3147414947 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2011 | ||||||||
| LastUpdateDate: | 08/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2011020321 | MO | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 046010493 | IL | N | Eye and Vision Services Providers | Optometrist | 152W00000X | OPC5294 | FL | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.