Healthcare Provider Details

I. General information

NPI: 1740792993
Provider Name (Legal Business Name): CHRISTIE NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2017
Last Update Date: 10/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 SUNVALLEY BLVD STE 110
CONCORD CA
94520-5816
US

IV. Provider business mailing address

1569 BROOKSIDE DR
SAN LEANDRO CA
94577-1301
US

V. Phone/Fax

Practice location:
  • Phone: 925-676-5638
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number33838TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: