MEDICARE: JIMMY QUANG OD INC

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

General Provider Information

NPI Number	:	1336787043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JIMMY QUANG OD INC

Provider Business Mailing Address
First Line	:	31401 RANCHO VIEJO RD STE 103
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-1850
Country	:	US
Telephone Number	:	510-637-9987
Fax Number	:	949-443-3828

Provider Business Practice Location Address
First Line	:	31401 RANCHO VIEJO RD STE 103
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-1850
Country	:	US
Telephone Number	:	949-443-3794
Fax Number	:	949-443-3828

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JIMMY QUANG
Credential	:	OD
Telephone Number	:	510-637-9987

Provider Enumeration Date	:	12/12/2019
Last Update Date	:	09/07/2024

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