Provider Demographics
NPI:1982757753
Name:NG, SANDY (OD)
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:NG
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 1:7375 DAY CREEK BLVD
Mailing Address - Street 2:SUITE #105
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-8022
Mailing Address - Country:US
Mailing Address - Phone:909-646-7443
Mailing Address - Fax:
Practice Address - Street 1:7375 DAY CREEK BLVD
Practice Address - Street 2:SUITE #105
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-8022
Practice Address - Country:US
Practice Address - Phone:909-646-7443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10719152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist