MEDICARE: DR. KARI V NGUYEN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	CA 9738T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114040540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARI V NGUYEN O.D.

Provider Business Mailing Address
First Line	:	541 S WEYMOUTH CT
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92807-4627
Country	:	US
Telephone Number	:	714-283-2752
Fax Number	:

Provider Business Practice Location Address
First Line	:	1081 N TUSTIN AVE STE 113
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92807-1737
Country	:	US
Telephone Number	:	714-632-1616
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/09/2007

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