Provider Demographics
NPI:1275247314
Name:TRACEY H NGUYEN OD & YUWEN LEE OD PROFESSIONAL OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:TRACEY H NGUYEN OD & YUWEN LEE OD PROFESSIONAL OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:559-584-1630
Mailing Address - Street 1:715 N IRWIN ST
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-3813
Mailing Address - Country:US
Mailing Address - Phone:559-584-1630
Mailing Address - Fax:
Practice Address - Street 1:715 N IRWIN ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3813
Practice Address - Country:US
Practice Address - Phone:559-584-1630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty