Provider Demographics
NPI:1902570914
Name:DO, NHUNG (OD)
Entity Type:Individual
Prefix:
First Name:NHUNG
Middle Name:
Last Name:DO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 W STEWART AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3647
Mailing Address - Country:US
Mailing Address - Phone:541-494-5325
Mailing Address - Fax:
Practice Address - Street 1:221 W STEWART AVE STE 110
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3647
Practice Address - Country:US
Practice Address - Phone:541-776-9026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORATI4593152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5000796034Medicaid