Provider Demographics
NPI:1902957202
Name:NGUYEN, TO-QUYEN THI (OD)
Entity Type:Individual
Prefix:
First Name:TO-QUYEN
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 EASTRIDGE MALL
Mailing Address - Street 2:ESTRIDGE MALL
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1427
Mailing Address - Country:US
Mailing Address - Phone:408-270-5424
Mailing Address - Fax:408-270-6176
Practice Address - Street 1:2855 STEVENS CREEK BLVD
Practice Address - Street 2:VALLEY FAIR MALL STE 1001
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-6709
Practice Address - Country:US
Practice Address - Phone:408-249-0705
Practice Address - Fax:408-249-2862
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10721T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0107210Medicare ID - Type Unspecified
CAU64608Medicare UPIN