Provider Demographics
NPI:1629121348
Name:NGUYEN, RYAN PHAT (OD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:PHAT
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 1:2413 HONEYBELL LN
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-1849
Mailing Address - Country:US
Mailing Address - Phone:858-382-4088
Mailing Address - Fax:
Practice Address - Street 1:1170 BROADWAY STE 130
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2760
Practice Address - Country:US
Practice Address - Phone:619-426-2451
Practice Address - Fax:619-426-2458
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12632T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist