Provider Demographics
NPI:1710177977
Name:NGUYEN, PHUONG NGOC (OD)
Entity Type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:670 NORTHRIDGE MALL # F8
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-2014
Mailing Address - Country:US
Mailing Address - Phone:831-443-5250
Mailing Address - Fax:831-443-6921
Practice Address - Street 1:1855 41ST AVE STE G11
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2509
Practice Address - Country:US
Practice Address - Phone:831-475-6519
Practice Address - Fax:831-475-0754
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 13294152W00000X
IL046.010012152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist