Provider Demographics
NPI:1588701601
Name:BUI, THANG Q (OD)
Entity type:Individual
Prefix:DR
First Name:THANG
Middle Name:Q
Last Name:BUI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:THANG
Other - Middle Name:Q
Other - Last Name:BUI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:416 N ROCK RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2211
Mailing Address - Country:US
Mailing Address - Phone:316-722-7376
Mailing Address - Fax:316-652-0512
Practice Address - Street 1:416 N ROCK RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2240
Practice Address - Country:US
Practice Address - Phone:316-722-7376
Practice Address - Fax:316-652-0512
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1783152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200586180AMedicaid