Provider Demographics
NPI:1750466777
Name:LA, QUYEN N (OD)
Entity Type:Individual
Prefix:DR
First Name:QUYEN
Middle Name:N
Last Name:LA
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 1:7251 WARNER AVE STE H
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-5487
Mailing Address - Country:US
Mailing Address - Phone:714-596-2258
Mailing Address - Fax:714-596-2248
Practice Address - Street 1:7251 WARNER AVE STE H
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-5487
Practice Address - Country:US
Practice Address - Phone:714-596-2258
Practice Address - Fax:714-596-2248
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12318T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0123180Medicaid
CAWOP12318AMedicare ID - Type UnspecifiedMEDICARE
CASD0123180Medicaid