Individual
KHA PHAN DUONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
278 N WICKHAM RD, MELBOURNE, FL 32935-8625
(321) 253-9228
Mailing address
278 N WICKHAM RD, MELBOURNE, FL 32935-8625
(321) 253-9228
(321) 253-9446
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
009864
FL
152W00000X
Optometrist
Primary
009864
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1295040202
NPI
—
Enumeration date
07/20/2023
Last updated
04/28/2026
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