MEDICARE: DR. CHRISTINA NGUYEN DEANE 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	OPT10150T	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SD0101500	OTHER	TX	MEDICARE ID

General Provider Information

NPI Number	:	1891796629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINA NGUYEN DEANE O.D.

Provider Business Mailing Address
First Line	:	220 MERIDIAN AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-2903
Country	:	US
Telephone Number	:	408-869-3400
Fax Number	:	408-998-1289

Provider Business Practice Location Address
First Line	:	220 MERIDIAN AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-2903
Country	:	US
Telephone Number	:	408-869-3400
Fax Number	:	408-998-1289

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	04/29/2020

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