Provider Demographics
NPI:1700496254
Name:GUAN, HENRY (OD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:GUAN
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 1:565 MAR VISTA DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-7518
Mailing Address - Country:US
Mailing Address - Phone:858-342-6493
Mailing Address - Fax:
Practice Address - Street 1:36330 HIDDEN SPRINGS RD STE A
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-5804
Practice Address - Country:US
Practice Address - Phone:951-609-9099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-08
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34601152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist