Provider Demographics
NPI:1780257188
Name:NGUON, VICKI UNG (OD)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:UNG
Last Name:NGUON
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 1:12467 COOL SPRINGS ST
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:91752-3412
Mailing Address - Country:US
Mailing Address - Phone:951-703-9067
Mailing Address - Fax:
Practice Address - Street 1:12467 COOL SPRINGS ST
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:91752-3412
Practice Address - Country:US
Practice Address - Phone:951-703-9067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34841152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist