Provider Demographics
NPI:1871871657
Name:XIN, DUYEN C (OD)
Entity type:Individual
Prefix:DR
First Name:DUYEN
Middle Name:C
Last Name:XIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:3750 GUNN HWY STE 108
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-8911
Mailing Address - Country:US
Mailing Address - Phone:813-712-0660
Mailing Address - Fax:813-315-7900
Practice Address - Street 1:211 E BROADWAY
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002
Practice Address - Country:US
Practice Address - Phone:618-462-9818
Practice Address - Fax:314-741-4947
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2011020321152W00000X
IL046010493152W00000X
FLOPC5294152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist