Provider Demographics
NPI:1528316924
Name:VU, PHUONG MAI DAO (OD)
Entity type:Individual
Prefix:DR
First Name:PHUONG MAI
Middle Name:DAO
Last Name:VU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MAI PHUONG
Other - Middle Name:DAO
Other - Last Name:VU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1741 E FLORENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222
Mailing Address - Country:US
Mailing Address - Phone:520-836-3357
Mailing Address - Fax:520-836-7531
Practice Address - Street 1:1741 E FLORENCE BLVD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222
Practice Address - Country:US
Practice Address - Phone:520-836-3357
Practice Address - Fax:520-836-7531
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1866152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ162079Medicare PIN
AZZ162074Medicare PIN
AZZ163024Medicare PIN