Provider Demographics
NPI:1225266463
Name:DIANA NGUYEN OPTOMETRY INC
Entity Type:Organization
Organization Name:DIANA NGUYEN OPTOMETRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:714-200-4261
Mailing Address - Street 1:903 S BRISTOL ST STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-4983
Mailing Address - Country:US
Mailing Address - Phone:714-564-9696
Mailing Address - Fax:714-784-7891
Practice Address - Street 1:903 S BRISTOL ST STE A
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-4983
Practice Address - Country:US
Practice Address - Phone:714-564-9696
Practice Address - Fax:714-784-7891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-25
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 12457 TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFP987AOtherMEDICARE PTAN
CAU99317Medicare UPIN
CAFP987AMedicare PIN