Provider Demographics
NPI:1548746241
Name:NGUYEN, QUAN-VINH BA (OD)
Entity Type:Individual
Prefix:
First Name:QUAN-VINH
Middle Name:BA
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 1:4441 E PALM AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-2923
Mailing Address - Country:US
Mailing Address - Phone:714-771-0914
Mailing Address - Fax:
Practice Address - Street 1:54 THE CROSSINGS, STE X & Y
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-4193
Practice Address - Country:US
Practice Address - Phone:518-373-2200
Practice Address - Fax:518-373-2350
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008836152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist