Provider Demographics
NPI:1770617805
Name:QUACH, PHUC HONG (OD)
Entity type:Individual
Prefix:DR
First Name:PHUC
Middle Name:HONG
Last Name:QUACH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:PHILIP
Other - Middle Name:
Other - Last Name:QUACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:23640 N ST BLDG 758
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92518-1893
Mailing Address - Country:US
Mailing Address - Phone:741-884-5064
Mailing Address - Fax:
Practice Address - Street 1:23640 N ST BLDG 758
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92518-1893
Practice Address - Country:US
Practice Address - Phone:951-656-9218
Practice Address - Fax:951-656-9237
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12891152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist