Healthcare Provider Details

I. General information

NPI: 1457413064
Provider Name (Legal Business Name): ANNE YEN NGUYEN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 12/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 LAWRENCE EXPY
SANTA CLARA CA
95051-5173
US

IV. Provider business mailing address

710 LAWRENCE EXPY
SANTA CLARA CA
95051-5173
US

V. Phone/Fax

Practice location:
  • Phone: 408-554-9830
  • Fax: 408-851-4403
Mailing address:
  • Phone: 408-554-9830
  • Fax: 408-851-4403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11713
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: