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General NPI Number Information
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NPI Number | 1487977096
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Entity Type | Organization
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Legal Business Name | SANTA ANA OPTOMETRY, INC
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Dates
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Enumeration Date | 03/10/2010
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Last Update Date | 03/10/2010
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Provider Practice Location Address
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Address Line | 2148 S BRISTOL ST STE C
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City | SANTA ANA
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State | CA
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Zip | 92704-5152
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Country | US
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Telephone | 714-662-7969
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Fax | 714-662-7964
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Provider Business Mailing Address
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Address Line | 2148 S BRISTOL ST STE C
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City | SANTA ANA
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State | CA
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Zip | 92704-5152
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Country | US
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Telephone | 714-662-7969
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Fax | 714-662-7964
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. THIEN-THU PHUC NGUYEN
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Credential | O.D
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Telephone | 714-662-7969
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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 | 13098T
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License Number State | CA
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