Provider Demographics
NPI:1033642392
Name:NGUYEN, PHUONG THI QUE (OD)
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:THI QUE
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3505 S TOWNER ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-3865
Mailing Address - Country:US
Mailing Address - Phone:714-914-7880
Mailing Address - Fax:
Practice Address - Street 1:9972 BOLSA AVE STE 105
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6069
Practice Address - Country:US
Practice Address - Phone:714-210-3405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33642T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist