Provider Demographics
NPI:1558661942
Name:JASMINE P. NGUYEN, O.D., INC.
Entity Type:Organization
Organization Name:JASMINE P. NGUYEN, O.D., INC.
Other - Org Name:FOCUS OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:PHUONG
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:619-284-3937
Mailing Address - Street 1:4029 43RD STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-8537
Mailing Address - Country:US
Mailing Address - Phone:619-284-3937
Mailing Address - Fax:619-284-3938
Practice Address - Street 1:4029 43RD STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-8537
Practice Address - Country:US
Practice Address - Phone:619-284-3937
Practice Address - Fax:619-284-3938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11189T261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP11189Medicare PIN