MEDICARE: MONIQUE M NGUYEN, OD, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WP0200X	Pediatric Optometrist	11931T	CA
2	152WS0006X	Sports Vision Optometrist	11931T	CA
3	152WV0400X	Vision Therapy Optometrist	11931T	CA
4	152W00000X	Optometrist	11931T	CA

General Provider Information

NPI Number	:	1376713123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONIQUE M NGUYEN, OD, INC

Provider Business Mailing Address
First Line	:	777 CORPORATE DR
Second Line	:	STE 200
City	:	LADERA RANCH
State	:	CA
Zip	:	92694-2135
Country	:	US
Telephone Number	:	949-364-4455
Fax Number	:	949-364-4419

Provider Business Practice Location Address
First Line	:	777 CORPORATE DR
Second Line	:	STE 200
City	:	LADERA RANCH
State	:	CA
Zip	:	92694-2135
Country	:	US
Telephone Number	:	949-364-4455
Fax Number	:	949-364-4419

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MONIQUE M NGUYEN
Credential	:	O.D.
Telephone Number	:	949-364-4455

Provider Enumeration Date	:	03/07/2008
Last Update Date	:	03/07/2008

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