Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 10370T | CA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 10370T | CA |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 10370T | CA |
NPI | 1225171713 |
---|---|
Provider Name | Van Tuyet Ly |
First Address | Fountain Valley, CA 92708-1311 |
Second Address | Fountain Valley, CA 92708-1311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 16/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
SD0103700 | (05) | CA |
U76545 | (02) | CA |