Individual
DR. CHINH T NGUYEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
87 W MARCH LN, SUITE 2, STOCKTON, CA 95207-5731
(209) 952-4647
(209) 952-4636
Mailing address
87 W MARCH LN, SUITE 2, STOCKTON, CA 95207-5731
(209) 952-4647
(209) 952-4636
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
11714T
CA
152WC0802X
Corneal and Contact Management Optometrist
11714T
CA
152WS0006X
Sports Vision Optometrist
11714T
CA
152WX0102X
Occupational Vision Optometrist
11714T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11714T
CALIFORNIA LICENSE
CA
05
—
1306921986
—
CA
01
—
P00737152
MEDICARE RAILROAD PTAN
CA
05
—
SD0117140
—
CA
Enumeration date
10/25/2006
Last updated
03/07/2023
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