Provider Demographics
NPI:1942339569
Name:NGUYEN, CYNTHIA THU (OD,)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:THU
Last Name:NGUYEN
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 1:1964 N TUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-3950
Mailing Address - Country:US
Mailing Address - Phone:714-282-0111
Mailing Address - Fax:714-282-0213
Practice Address - Street 1:1964 N TUSTIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-3950
Practice Address - Country:US
Practice Address - Phone:714-282-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10271T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0102710Medicaid
CAU56067Medicare UPIN
CAOP10271Medicare ID - Type UnspecifiedMEDICARE