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General NPI Number Information
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NPI Number | 1710177977
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Entity Type | Individual
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Provider Name | PHUONG NGOC NGUYEN O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 01/10/2023
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Provider Practice Location Address
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Address Line | 1855 41ST AVE STE G11
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City | CAPITOLA
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State | CA
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Zip | 95010-2509
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Country | US
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Telephone | 831-475-6519
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Fax | 831-475-0754
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Provider Business Mailing Address
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Address Line | 670 NORTHRIDGE MALL # F8
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City | SALINAS
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State | CA
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Zip | 93906-2014
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Country | US
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Telephone | 831-443-5250
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Fax | 831-443-6921
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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 | OPT 13294
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046.010012
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License Number State | IL
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