Provider Demographics
NPI:1710045174
Name:HENRY NGUYEN, OD, INC.
Entity Type:Organization
Organization Name:HENRY NGUYEN, OD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:951-656-3693
Mailing Address - Street 1:23080 ALESSANDRO BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-9673
Mailing Address - Country:US
Mailing Address - Phone:951-656-3693
Mailing Address - Fax:951-656-3825
Practice Address - Street 1:23080 ALESSANDRO BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-9673
Practice Address - Country:US
Practice Address - Phone:951-656-3693
Practice Address - Fax:951-656-3825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11717T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU95419Medicare UPIN