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General NPI Number Information
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NPI Number | 1457895187
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Entity Type | Organization
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Legal Business Name | DR TOAN A NGUYEN OD INC
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Dates
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Enumeration Date | 12/14/2016
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Last Update Date | 12/14/2016
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Provider Practice Location Address
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Address Line | 2154 HUNTINGTON DR
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City | SAN MARINO
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State | CA
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Zip | 91108-2024
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Country | US
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Telephone | 316-990-1585
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Fax |
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Provider Business Mailing Address
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Address Line | 13250 DON JULIAN RD
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City | LA PUENTE
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State | CA
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Zip | 91746-2239
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TOAN NGUYEN
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Credential | O.D.
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Telephone | 316-990-1585
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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 | 33446
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License Number State | CA
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