Provider Demographics
NPI:1902028962
Name:NGO, TRI (OD)
Entity Type:Individual
Prefix:
First Name:TRI
Middle Name:
Last Name:NGO
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 1:12053 SYCAMORE LANE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843
Mailing Address - Country:US
Mailing Address - Phone:714-534-9161
Mailing Address - Fax:
Practice Address - Street 1:9656 LAS TUNAS DR
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-2139
Practice Address - Country:US
Practice Address - Phone:626-286-1993
Practice Address - Fax:626-286-1903
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12745TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP12745OtherPIN
CAV08316Medicare UPIN