Provider Demographics
NPI:1760971402
Name:NGUYEN, VU (OD)
Entity Type:Individual
Prefix:
First Name:VU
Middle Name:
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 1:2860 S BRISTOL ST
Mailing Address - Street 2:STE D
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-6200
Mailing Address - Country:US
Mailing Address - Phone:714-540-3993
Mailing Address - Fax:844-231-8874
Practice Address - Street 1:17230 NEWHOPE ST APT 104
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-8211
Practice Address - Country:US
Practice Address - Phone:408-472-7037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT33914-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist