1578770525 NPI number — MY-HANH TRIEU OD, INC.

Table of content: (NPI 1578770525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578770525 NPI number — MY-HANH TRIEU OD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MY-HANH TRIEU OD, INC.
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:
Provider Other Organization Name Type Code:
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:
1578770525
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6015A WILSON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22205-1503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-534-8801
Provider Business Mailing Address Fax Number:
703-534-8803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6015A WILSON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22205-1503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-534-8801
Provider Business Practice Location Address Fax Number:
703-534-8803
Provider Enumeration Date:
05/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TRIEU
Authorized Official First Name:
MY-HANH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
703-534-8801

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WX0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 10051304 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1202001 . This is a "ALLIED EYECARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: J254 . This is a "BCBS PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 487248 . This is a "NVA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: TE23963 . This is a "SPECTERA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: VA02285 . This is a "VISION BENEFIT OF AMERICA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: VA2285 . This is a "EYEMED" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 137406 . This is a "ANTHEM PPO, HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 44447 . This is a "DAVIS VISION" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 31691 . This is a "AVESIS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 469475 . This is a "MAMSI,MDIPA,UNITED HC," identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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