Provider Demographics
NPI:1609007533
Name:QUACH, NGUYEN HUNG (OD)
Entity Type:Individual
Prefix:DR
First Name:NGUYEN
Middle Name:HUNG
Last Name:QUACH
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 1:734 LEFEVRE CT
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6188
Mailing Address - Country:US
Mailing Address - Phone:530-723-4005
Mailing Address - Fax:888-789-5412
Practice Address - Street 1:1880 PRAIRIE CITY RD
Practice Address - Street 2:SUITE 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:888-789-4512
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13774152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1558768374OtherBUSINESS NPI