Provider Demographics
NPI:1568120079
Name:SANTA ANA FAMILY OPTOMETRY
Entity Type:Organization
Organization Name:SANTA ANA FAMILY OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-839-1515
Mailing Address - Street 1:3750 W MCFADDEN AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-1388
Mailing Address - Country:US
Mailing Address - Phone:714-839-1515
Mailing Address - Fax:
Practice Address - Street 1:3750 W MCFADDEN AVE STE C
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-1388
Practice Address - Country:US
Practice Address - Phone:714-839-1515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATHAN T DO , O.D. APC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-01
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1750419743Medicaid
CACB214302Medicaid