Provider Demographics
NPI:1497945323
Name:NGUYEN, SANDY (OD)
Entity Type:Individual
Prefix:DR
First Name:SANDY
Middle Name:
Last Name:NGUYEN
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 1:9969 WYATT RANCH WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-8019
Mailing Address - Country:US
Mailing Address - Phone:916-478-1004
Mailing Address - Fax:
Practice Address - Street 1:330 N BRAND BLVD STE 110
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2308
Practice Address - Country:US
Practice Address - Phone:818-240-8090
Practice Address - Fax:818-246-2540
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13340152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1306035118OtherGROUP NUMBER NPI
CABF492AOtherMEDICARE PIN
CABR184Medicare PIN
CABF527ZMedicare PIN
CADP2509Medicare PIN
CABF492AOtherMEDICARE PIN
CAP00741246Medicare PIN