Provider Demographics
NPI:1114156684
Name:NG, EILEEN (OD)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:NG
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 1:9820 BRIMHALL RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-2787
Mailing Address - Country:US
Mailing Address - Phone:661-213-3000
Mailing Address - Fax:661-213-3101
Practice Address - Street 1:9820 BRIMHALL RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2787
Practice Address - Country:US
Practice Address - Phone:661-213-3000
Practice Address - Fax:661-213-3101
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13771152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1114156684Medicaid
CAFH482ZMedicare PIN