Provider Demographics
NPI:1184636433
Name:NGUYEN, BRITTANY (O D)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7082 EMERSON LN
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5665
Mailing Address - Country:US
Mailing Address - Phone:408-828-5005
Mailing Address - Fax:
Practice Address - Street 1:815 BROADWAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4015
Practice Address - Country:US
Practice Address - Phone:510-465-5876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 10398 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0103981Medicaid
CASD0103981Medicaid
CAU76400Medicare UPIN