Provider Demographics
NPI:1033542071
Name:NGO, ANDREW THIEN (OD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:THIEN
Last Name:NGO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 RENAISSANCE PKWY STE 1050
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-2414
Mailing Address - Country:US
Mailing Address - Phone:909-546-3465
Mailing Address - Fax:
Practice Address - Street 1:1175 RENAISSANCE PKWY STE 1050
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-2414
Practice Address - Country:US
Practice Address - Phone:623-486-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3522AT152W00000X
CA34436-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist