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General NPI Number Information
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NPI Number | 1164205613
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Entity Type | Organization
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Legal Business Name | CATHY NGUYEN, O.D., A PROFESSIONAL OPTOMETRIC CORPORATION
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Dates
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Enumeration Date | 08/17/2023
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Last Update Date | 08/31/2023
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Provider Practice Location Address
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Address Line | 8190 MANGO AVE
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City | FONTANA
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State | CA
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Zip | 92335-3610
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Country | US
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Telephone | 909-350-2020
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Fax | 909-350-2341
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Provider Business Mailing Address
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Address Line | 8190 MANGO AVE
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City | FONTANA
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State | CA
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Zip | 92335-3610
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Country | US
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Telephone | 909-350-2020
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Fax | 909-350-2341
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | CATHY NGUYEN
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Credential | OD
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Telephone | 909-350-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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