Provider Demographics
NPI:1164205613
Name:CATHY NGUYEN, O.D., A PROFESSIONAL OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:CATHY NGUYEN, O.D., A PROFESSIONAL OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:909-350-2020
Mailing Address - Street 1:8190 MANGO AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3610
Mailing Address - Country:US
Mailing Address - Phone:909-350-2020
Mailing Address - Fax:909-350-2341
Practice Address - Street 1:8190 MANGO AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3610
Practice Address - Country:US
Practice Address - Phone:909-350-2020
Practice Address - Fax:909-350-2341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-17
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty