Provider Demographics
NPI:1124016183
Name:NGUYEN, ANH-LINH TERESA (OD)
Entity Type:Individual
Prefix:
First Name:ANH-LINH
Middle Name:TERESA
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 1:3801 S HARBOR BLVD
Mailing Address - Street 2:STE C
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7901
Mailing Address - Country:US
Mailing Address - Phone:714-531-9900
Mailing Address - Fax:714-531-0236
Practice Address - Street 1:3801 S HARBOR BLVD
Practice Address - Street 2:STE C
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-7901
Practice Address - Country:US
Practice Address - Phone:714-553-1990
Practice Address - Fax:714-531-0236
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10146T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0101460Medicaid
U53409Medicare UPIN
CASD0101460Medicaid