Provider Demographics
NPI:1962406454
Name:VO, MIEU D (OD)
Entity type:Individual
Prefix:
First Name:MIEU
Middle Name:D
Last Name:VO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 INDEPENDENCE WAY
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1280
Mailing Address - Country:US
Mailing Address - Phone:781-588-7029
Mailing Address - Fax:781-585-1880
Practice Address - Street 1:101 INDEPENDENCE MALL WAY
Practice Address - Street 2:C/O LENSCRAFTERS
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-3048
Practice Address - Country:US
Practice Address - Phone:781-585-6883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4359152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA95328OtherHARVARD PILGRIM
MA0329312Medicaid
MA469654OtherTUFTS
MA4359OtherTPA OPTOMETRIST LIC. MA
MA9785141Medicaid
MAW16374OtherBCBS MA
MAAA95328OtherHARVARD PILGRIM
MAW17480Medicare ID - Type UnspecifiedMEDICARE