Provider Demographics
NPI:1376772848
Name:NG, DOREEN ANDREA (OD)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:ANDREA
Last Name:NG
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 1:3592 S ATHERTON BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-7444
Mailing Address - Country:US
Mailing Address - Phone:480-988-4131
Mailing Address - Fax:
Practice Address - Street 1:3592 S ATHERTON BLVD STE 111
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7444
Practice Address - Country:US
Practice Address - Phone:480-988-4131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2087152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist