Provider Demographics
NPI:1285832501
Name:DUONG, NGHI UYEN (OD)
Entity Type:Individual
Prefix:DR
First Name:NGHI
Middle Name:UYEN
Last Name:DUONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635B S RANCHO SANTA FE RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-3973
Mailing Address - Country:US
Mailing Address - Phone:760-744-0767
Mailing Address - Fax:760-744-2892
Practice Address - Street 1:635B S RANCHO SANTA FE RD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-3973
Practice Address - Country:US
Practice Address - Phone:760-744-0767
Practice Address - Fax:760-744-2892
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-09
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12803152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFX964ZMedicare PIN