Individual
CUC THI VAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1536 N JEFFERSON ST, JACKSONVILLE, FL 32209-6525
(904) 475-6310
(352) 384-8015
Mailing address
1905 PROMENADE WAY APT 1409, JACKSONVILLE, FL 32207-3588
(910) 264-7265
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG003814
PA
Other
Enumeration date
03/21/2022
Last updated
03/28/2022
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