Healthcare Provider Details

I. General information

NPI: 1821684028
Provider Name (Legal Business Name): AMY THIEN HUONG TSE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2020
Last Update Date: 12/12/2020
Certification Date: 12/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LAGUNA RD STE C
FULLERTON CA
92835-3637
US

IV. Provider business mailing address

18424 SANTANA AVE
CERRITOS CA
90703-8038
US

V. Phone/Fax

Practice location:
  • Phone: 714-888-2080
  • Fax:
Mailing address:
  • Phone: 714-566-5363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number34735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: