Provider Demographics
NPI:1770648743
Name:NGUYEN, VANCE T (OD)
Entity Type:Individual
Prefix:DR
First Name:VANCE
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:VANG
Other - Middle Name:T
Other - Last Name:NGUIYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3920 GRAND AVE STE D
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5484
Mailing Address - Country:US
Mailing Address - Phone:909-613-1644
Mailing Address - Fax:909-613-1646
Practice Address - Street 1:3920 GRAND AVE STE D
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5484
Practice Address - Country:US
Practice Address - Phone:909-613-1644
Practice Address - Fax:909-613-1646
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 9741152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist