Provider Demographics
NPI:1033721063
Name:NGUYEN, JUSTIN TUAN-ANH (OD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:TUAN-ANH
Last Name:NGUYEN
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 1:10691 OAKBEND DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-2372
Mailing Address - Country:US
Mailing Address - Phone:408-202-1695
Mailing Address - Fax:
Practice Address - Street 1:890 EASTLAKE PKWY STE 102
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4521
Practice Address - Country:US
Practice Address - Phone:619-216-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34609152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist