Provider Demographics
NPI:1972650737
Name:BATT, LAN NGUYEN (OD)
Entity Type:Individual
Prefix:DR
First Name:LAN
Middle Name:NGUYEN
Last Name:BATT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LAN
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1855 41ST AVE. #G-11
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010
Mailing Address - Country:US
Mailing Address - Phone:831-475-6519
Mailing Address - Fax:
Practice Address - Street 1:1855 41ST AVE.
Practice Address - Street 2:#G-11
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010
Practice Address - Country:US
Practice Address - Phone:831-475-6519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9918152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU44076Medicare UPIN