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General NPI Number Information
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NPI Number | 1518763796
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Entity Type | Organization
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Legal Business Name | DR. QUAN & ASSOCIATES OPTOMETRIC CORP
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Dates
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Enumeration Date | 02/20/2025
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 1800 N PERRIS BLVD
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City | PERRIS
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State | CA
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Zip | 92571-2701
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Country | US
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Telephone | 951-561-0137
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Fax |
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Provider Business Mailing Address
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Address Line | 23291 SAND CANYON CIR
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City | CORONA
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State | CA
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Zip | 92883-5085
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Country | US
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Telephone | 951-454-9782
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | QUAN NGOC NGUYEN
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Credential | OD
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Telephone | 951-454-9782
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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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