Provider Demographics
NPI:1265840102
Name:NGUYEN, HAN (OD)
Entity Type:Individual
Prefix:DR
First Name:HAN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9629 RIDGEROCK DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-4461
Mailing Address - Country:US
Mailing Address - Phone:916-743-8362
Mailing Address - Fax:
Practice Address - Street 1:1800 CAVITT DR
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-6235
Practice Address - Country:US
Practice Address - Phone:916-983-1148
Practice Address - Fax:916-983-1192
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33366-TLG152W00000X
CA33366TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33366TLGOtherCA STATE BOARD OF OPTOMETRY