Provider Demographics
NPI:1518525401
Name:VU, NICOLAS (OD)
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:
Last Name:VU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-4112
Mailing Address - Country:US
Mailing Address - Phone:336-249-8901
Mailing Address - Fax:888-868-8953
Practice Address - Street 1:504 E CENTER ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-4112
Practice Address - Country:US
Practice Address - Phone:336-249-8901
Practice Address - Fax:888-868-8953
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2612152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program