1003005356 NPI number — A BETTER VUE EYE PHYSICIANS

Table of content: (NPI 1003005356)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003005356 NPI number — A BETTER VUE EYE PHYSICIANS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A BETTER VUE EYE PHYSICIANS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DAVID TRAN M.D. LANI VU M.D.
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003005356
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1333 3RD AVE S STE 301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34102-6499
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-262-2020
Provider Business Mailing Address Fax Number:
239-435-1084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1333 3RD AVE S STE 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34102-6499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-262-2020
Provider Business Practice Location Address Fax Number:
239-435-1084
Provider Enumeration Date:
10/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VU
Authorized Official First Name:
LANI
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
239-262-2020

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  11-64-00052 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AF933 . This is a "MEDICARE PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 107616500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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