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Organization
LAKESIDE OPTOMETRY, PC
Active
Organization
LAKESIDE OPTOMETRY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHINH T. NGUYEN O.D. (PRESIDENT)
(209) 451-4305
Entity
Organization
Contact information
Practice address
3461 BROOKSIDE RD STE A-1, STOCKTON, CA 95219-1741
(209) 451-4305
(209) 622-4283
Mailing address
3461 BROOKSIDE RD STE A-1, STOCKTON, CA 95219-1741
(209) 451-4305
(209) 622-4283
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
11714T
CA
152W00000X
Optometrist
OPT 12656 TPL
CA
Other
Enumeration date
10/26/2016
Last updated
10/26/2016
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