Provider Demographics
NPI:1235218082
Name:VU, LEE NGUYEN (OD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:NGUYEN
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 1:9616 N LAMAR BLVD
Mailing Address - Street 2:STE. 159
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-4250
Mailing Address - Country:US
Mailing Address - Phone:512-835-9226
Mailing Address - Fax:512-835-7423
Practice Address - Street 1:9616 N LAMAR BLVD
Practice Address - Street 2:STE. 159
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-4150
Practice Address - Country:US
Practice Address - Phone:512-835-9226
Practice Address - Fax:512-835-7413
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05217T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0418196-02Medicaid
TX0418196-02Medicaid
TX8D4093Medicare ID - Type UnspecifiedMEDICARE