Healthcare Provider Details

I. General information

NPI: 1275651408
Provider Name (Legal Business Name): ANDREA CHAU NGUYEN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26502 TOWNE CENTRE DR
FOOTHILL RANCH CA
92610-2417
US

IV. Provider business mailing address

10164 CARDINAL AVE
FOUNTAIN VALLEY CA
92708-7402
US

V. Phone/Fax

Practice location:
  • Phone: 949-588-7520
  • Fax: 949-588-6082
Mailing address:
  • Phone: 714-968-9120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12628
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: