Provider Demographics
NPI:1831226497
Name:NGUYEN, ANN VI (OD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:VI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:VI
Other - Middle Name:ANNE
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2655 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-8918
Mailing Address - Country:US
Mailing Address - Phone:714-592-3222
Mailing Address - Fax:562-621-9020
Practice Address - Street 1:2655 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-8918
Practice Address - Country:US
Practice Address - Phone:562-621-0656
Practice Address - Fax:562-621-9020
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12227152W00000X
CA12227T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0122270Medicaid