Provider Demographics
NPI:1407912074
Name:QUACH, PHUNG MY (OD)
Entity Type:Individual
Prefix:
First Name:PHUNG
Middle Name:MY
Last Name:QUACH
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 1:9002 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5516
Mailing Address - Country:US
Mailing Address - Phone:714-894-8401
Mailing Address - Fax:
Practice Address - Street 1:9600 BOLSA AVE
Practice Address - Street 2:STE C & H
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5949
Practice Address - Country:US
Practice Address - Phone:714-775-7045
Practice Address - Fax:714-775-7050
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12643T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist