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General NPI Number Information
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NPI Number | 1629121348
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Entity Type | Individual
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Provider Name | RYAN PHAT NGUYEN O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 05/16/2016
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Provider Practice Location Address
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Address Line | 1170 BROADWAY STE 130
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City | CHULA VISTA
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State | CA
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Zip | 91911-2760
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Country | US
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Telephone | 619-426-2451
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Fax | 619-426-2458
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Provider Business Mailing Address
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Address Line | 2413 HONEYBELL LN
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City | ESCONDIDO
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State | CA
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Zip | 92027-1849
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Country | US
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Telephone | 858-382-4088
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 12632T
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License Number State | CA
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