Provider Demographics
NPI:1558768374
Name:NGUYEN QUACH OD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:NGUYEN QUACH OD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NGUYEN
Authorized Official - Middle Name:HUNG
Authorized Official - Last Name:QUACH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:530-723-4005
Mailing Address - Street 1:1880 PRAIRIE CITY RD
Mailing Address - Street 2:STE 130
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-9593
Mailing Address - Country:US
Mailing Address - Phone:916-985-7848
Mailing Address - Fax:888-789-5412
Practice Address - Street 1:1880 PRAIRIE CITY RD
Practice Address - Street 2:STE 130
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-9593
Practice Address - Country:US
Practice Address - Phone:916-985-7848
Practice Address - Fax:888-789-5412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-21
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13774152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1558768374OtherNGUYEN QUACH OD A PROFESSIONAL CORPORATION