Provider Demographics
NPI:1790854958
Name:NG, NOLAN R (OD)
Entity Type:Individual
Prefix:DR
First Name:NOLAN
Middle Name:R
Last Name:NG
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 1:2551 PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-7035
Mailing Address - Country:US
Mailing Address - Phone:310-326-2881
Mailing Address - Fax:310-326-5242
Practice Address - Street 1:2551 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-7035
Practice Address - Country:US
Practice Address - Phone:310-326-2881
Practice Address - Fax:310-326-5242
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10145TLG152WC0802X
CA10145T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10145TLGOtherCA LICENSE
CA10145TOtherCA LICENSE
CA10145TOtherCA LICENSE