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General NPI Number Information
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NPI Number | 1487010906
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Entity Type | Organization
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Legal Business Name | NGUYEN AND LAC, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/13/2016
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Last Update Date | 01/13/2016
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Provider Practice Location Address
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Address Line | 12345 MOUNTAIN AVE SUITE X
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City | CHINO
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State | CA
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Zip | 91710-2783
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Country | US
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Telephone | 909-548-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 12345 MOUNTAIN AVE SUITE X
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City | CHINO
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State | CA
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Zip | 91710-2783
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Country | US
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Telephone | 909-548-0300
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. QUYEN CAM LAC
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Credential | O.D.
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Telephone | 714-785-0333
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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 | 13154T
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License Number State | CA
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