Healthcare Provider Details

I. General information

NPI: 1134034606
Provider Name (Legal Business Name): DR. QUAN & ASSOCIATES OPTOMETRIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N PERRIS BLVD
PERRIS CA
92571-2701
US

IV. Provider business mailing address

23291 SAND CANYON CIR
CORONA CA
92883-5085
US

V. Phone/Fax

Practice location:
  • Phone: 951-561-0137
  • Fax: 951-346-3243
Mailing address:
  • Phone: 951-454-9782
  • Fax: 951-346-3243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. QUAN ANH NGOC NGUYEN
Title or Position: CEO/PRESIDENT
Credential: OD
Phone: 951-454-9782