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Individual
QUANG NGUYEN
Active
Individual
QUANG NGUYEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT11814
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0052930
—
CA
01
—
OPT11814
STATE LICENSE NUMBER
CA
Enumeration date
10/31/2005
Last updated
11/29/2021
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