Provider Demographics
NPI:1295846814
Name:TA, ASHLEY MYTRINH (OD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:MYTRINH
Last Name:TA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:39901 WILLOWBEND DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-5209
Mailing Address - Country:US
Mailing Address - Phone:727-656-0347
Mailing Address - Fax:727-373-1975
Practice Address - Street 1:30688 BENTON RD STE B101
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:CA
Practice Address - Zip Code:92596-8469
Practice Address - Country:US
Practice Address - Phone:951-926-4411
Practice Address - Fax:951-926-4399
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOPC3834152W00000X, 152WC0802X
CAOPT12442152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management