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General NPI Number Information
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NPI Number | 1902957202
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Entity Type | Individual
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Provider Name | TO-QUYEN THI NGUYEN O.D.
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Gender | Female
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2855 STEVENS CREEK BLVD VALLEY FAIR MALL STE 1001
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City | SANTA CLARA
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State | CA
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Zip | 95050-6709
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Country | US
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Telephone | 408-249-0705
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Fax | 408-249-2862
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Provider Business Mailing Address
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Address Line | 152 EASTRIDGE MALL ESTRIDGE MALL
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City | SAN JOSE
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State | CA
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Zip | 95122-1427
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Country | US
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Telephone | 408-270-5424
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Fax | 408-270-6176
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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 | 10721T
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License Number State | CA
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