Individual provider Active NPI

Dawn Thanh Vu, O.D.

  • Optometrist
  • Tustin, CA
National Provider Identifier
1255325296
Registry record updated Jan 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
12373T Issued in CA
Practice address
700 W 1St St Ste 1
Tustin, CA 92780-2948
Phone
(714) 547-6819
Fax
(714) 547-6070
NPI assigned
Sep 6, 2005
Reactivated
Apr 18, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 15, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 12373T CA Primary

Addresses

Primary practice location

700 W 1St St Ste 1
Tustin, CA 92780-2948

Mailing address

700 W 1St St Ste 1
Tustin, CA 92780-2948
Phone (714) 547-6819

Other practice location 1

516 E Palmdale Blvd
Palmdale, CA 93550-4603
Phone (661) 273-7200

Other identifiers 1

IdentifierTypeStateIssuer
SD012373MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031120000425 CA Practitioner - Optometry 9638073851 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12373TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Baker & Vu an Optometric Professional Corporation Optometrist CurrentSince Nov 18, 2022 Accepting new patients
Rodman Sandoval, O.D., Inc. Optometrist Past Accepting new patients
Dignity Health Medical Foundation Past Accepting new patients

Locations

516 E Palmdale Blvd
Palmdale, CA 93550
Phone (661) 273-7200

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673740800000",
    "number": "1255325296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 W 1ST ST STE 1",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927802948",
            "telephone_number": "714-547-6819",
            "fax_number": "661-273-4545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 W 1ST ST STE 1",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927802948",
            "telephone_number": "714-547-6819",
            "fax_number": "714-547-6070"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "516 E Palmdale Blvd",
            "address_purpose": "LOCATION",
            "city": "Palmdale",
            "state": "CA",
            "postal_code": "935504603",
            "country_code": "US",
            "telephone_number": "661-273-7200",
            "fax_number": "661-273-4545",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VU",
        "first_name": "DAWN",
        "middle_name": "THANH",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-09-06",
        "last_updated": "2023-01-15",
        "certification_date": "2023-01-15",
        "deactivation_date": "2006-03-24",
        "reactivation_date": "2006-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "12373T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD012373",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

Verify at the official NPI Registry.