MEDICARE: MISS CHRISTINE ANH MAI NGUYEN-LE 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	11519	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	:	1659446136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CHRISTINE ANH MAI NGUYEN-LE O.D.

Provider Business Mailing Address
First Line	:	15382 WILSON ST
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-6341
Country	:	US
Telephone Number	:	714-548-1481
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 CHINO HILLS PKWY
Second Line	:	STE 810
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-3785
Country	:	US
Telephone Number	:	909-479-8111
Fax Number	:

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	01/04/2020

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