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General NPI Number Information
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NPI Number | 1841446176
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Entity Type | Individual
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Provider Name | DUONG DAI NGUYEN O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 06/19/2017
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Provider Practice Location Address
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Address Line | 5051 CANYON CREST DR SUITE 102
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City | RIVERSIDE
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State | CA
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Zip | 92507-6035
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Country | US
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Telephone | 832-878-6082
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Fax |
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Provider Business Mailing Address
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Address Line | 303 BROADWAY ST STE 105
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-1816
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Country | US
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Telephone |
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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 | 7271T
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License Number State | TX
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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 | 13699TLG
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License Number State | CA
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