Provider Demographics
NPI:1730732579
Name:DUONG, LISA NGOC (OD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:NGOC
Last Name:DUONG
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 1:3614 S MARYLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3033
Mailing Address - Country:US
Mailing Address - Phone:702-737-8893
Mailing Address - Fax:702-737-5784
Practice Address - Street 1:3614 S MARYLAND PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3033
Practice Address - Country:US
Practice Address - Phone:702-737-8893
Practice Address - Fax:702-737-5784
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist