MEDICARE: DR. QUYEN N. LA O.D.

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	152W00000X	Optometrist	12318T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750466777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. QUYEN N. LA O.D.

Provider Business Mailing Address
First Line	:	7251 WARNER AVE STE H
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-5487
Country	:	US
Telephone Number	:	714-596-2258
Fax Number	:	714-596-2248

Provider Business Practice Location Address
First Line	:	7251 WARNER AVE STE H
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-5487
Country	:	US
Telephone Number	:	714-596-2258
Fax Number	:	714-596-2248

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/09/2007

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