MEDICARE: ANDREA CHAU 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	12628	CA

General Provider Information

NPI Number	:	1275651408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA CHAU NGUYEN O.D.

Provider Business Mailing Address
First Line	:	10164 CARDINAL AVE
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-7402
Country	:	US
Telephone Number	:	714-968-9120
Fax Number	:

Provider Business Practice Location Address
First Line	:	26502 TOWNE CENTRE DR
Second Line	:
City	:	FOOTHILL RANCH
State	:	CA
Zip	:	92610-2417
Country	:	US
Telephone Number	:	949-588-7520
Fax Number	:	949-588-6082

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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