MEDICARE: DOREEN ANDREA NG OD

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	2087	AZ

General Provider Information

NPI Number	:	1376772848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOREEN ANDREA NG OD

Provider Business Mailing Address
First Line	:	3592 S ATHERTON BLVD STE 111
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85297-7444
Country	:	US
Telephone Number	:	480-988-4131
Fax Number	:

Provider Business Practice Location Address
First Line	:	3592 S ATHERTON BLVD STE 111
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85297-7444
Country	:	US
Telephone Number	:	480-988-4131
Fax Number	:

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

Provider Enumeration Date	:	07/06/2009
Last Update Date	:	11/13/2017

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