Provider Demographics
NPI:1114252954
Name:LY, NHU QUYNH (OD)
Entity Type:Individual
Prefix:
First Name:NHU
Middle Name:QUYNH
Last Name:LY
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 1:8422 CARNEGIE AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7604
Mailing Address - Country:US
Mailing Address - Phone:714-657-9996
Mailing Address - Fax:
Practice Address - Street 1:1002 N FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-1811
Practice Address - Country:US
Practice Address - Phone:714-617-2296
Practice Address - Fax:714-689-6045
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13825152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist