Provider Demographics
NPI:1003043860
Name:NGUYEN, THANH-VI LE (OD)
Entity Type:Individual
Prefix:DR
First Name:THANH-VI
Middle Name:LE
Last Name:NGUYEN
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 1:79710 HIGHWAY 111
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-6516
Mailing Address - Country:US
Mailing Address - Phone:760-342-6900
Mailing Address - Fax:
Practice Address - Street 1:79710 HIGHWAY 111 STE 101
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-6516
Practice Address - Country:US
Practice Address - Phone:760-342-6900
Practice Address - Fax:760-841-5403
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13902152W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program