Healthcare Provider Details

I. General information

NPI: 1760971402
Provider Name (Legal Business Name): VU NGUYEN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 PLEASANT GROVE BLVD STE 150
ROSEVILLE CA
95678-7215
US

IV. Provider business mailing address

9370 BEAR GRASS CIR
SACRAMENTO CA
95829-8707
US

V. Phone/Fax

Practice location:
  • Phone: 916-797-3937
  • Fax:
Mailing address:
  • Phone: 408-472-7037
  • Fax: 916-442-4928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT33914-TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: