Provider Demographics
NPI:1528039740
Name:NGUYEN, LIZ (OD)
Entity Type:Individual
Prefix:DR
First Name:LIZ
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 1:110 W BIRCH ST
Mailing Address - Street 2:UNIT 3
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-4956
Mailing Address - Country:US
Mailing Address - Phone:714-529-9907
Mailing Address - Fax:714-529-9577
Practice Address - Street 1:110 W BIRCH ST
Practice Address - Street 2:UNIT 3
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-4956
Practice Address - Country:US
Practice Address - Phone:714-529-9907
Practice Address - Fax:714-529-9577
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11374T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACZ746ZMedicare PIN