Healthcare Provider Details

I. General information

NPI: 1831226497
Provider Name (Legal Business Name): ANN VI NGUYEN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VI ANNE NGUYEN

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 EL CAMINO REAL
TUSTIN CA
92782-8918
US

IV. Provider business mailing address

2655 EL CAMINO REAL
TUSTIN CA
92782-8918
US

V. Phone/Fax

Practice location:
  • Phone: 562-621-0656
  • Fax: 562-621-9020
Mailing address:
  • Phone: 714-592-3222
  • Fax: 562-621-9020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12227
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12227T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: