Provider Demographics
NPI:1487010906
Name:NGUYEN AND LAC, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:NGUYEN AND LAC, A PROFESSIONAL CORPORATION
Other - Org Name:THE VISION SHOP OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:QUYEN
Authorized Official - Middle Name:CAM
Authorized Official - Last Name:LAC
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-785-0333
Mailing Address - Street 1:12345 MOUNTAIN AVE
Mailing Address - Street 2:SUITE X
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2783
Mailing Address - Country:US
Mailing Address - Phone:909-548-0300
Mailing Address - Fax:
Practice Address - Street 1:12345 MOUNTAIN AVE
Practice Address - Street 2:SUITE X
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2783
Practice Address - Country:US
Practice Address - Phone:909-548-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13154T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty