Provider Demographics
NPI:1073666897
Name:NGUYEN, CONNIE (OD)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
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:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-0567
Mailing Address - Country:US
Mailing Address - Phone:760-650-5228
Mailing Address - Fax:
Practice Address - Street 1:1822 MARRON RD
Practice Address - Street 2:NORTH COUNTY PLAZA #100
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1172
Practice Address - Country:US
Practice Address - Phone:760-434-7620
Practice Address - Fax:760-434-3069
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAT12914152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist