Provider Demographics
NPI:1528038486
Name:NGUYEN, QUINN Q (OD)
Entity Type:Individual
Prefix:DR
First Name:QUINN
Middle Name:Q
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 W ROBINHOOD DR STE E
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5626
Mailing Address - Country:US
Mailing Address - Phone:209-476-7040
Mailing Address - Fax:209-476-7041
Practice Address - Street 1:1111 W ROBINHOOD DR STE E
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5626
Practice Address - Country:US
Practice Address - Phone:209-476-7040
Practice Address - Fax:209-476-7041
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT11194TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1588824320Medicaid
CA5290730001Medicare NSC
CABG752ZMedicare PIN