Provider Demographics
NPI:1689786378
Name:NGUYEN, NANCY NGOC (OD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13020 CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-4349
Mailing Address - Country:US
Mailing Address - Phone:714-663-2638
Mailing Address - Fax:714-663-2600
Practice Address - Street 1:13020 CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4349
Practice Address - Country:US
Practice Address - Phone:714-663-2638
Practice Address - Fax:714-663-2600
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12631152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABM795AMedicare PIN