Provider Demographics
NPI:1861170573
Name:NGUYEN, VIET HOANG (OD)
Entity type:Individual
Prefix:
First Name:VIET
Middle Name:HOANG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 LEBON DR UNIT 3506
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-4504
Mailing Address - Country:US
Mailing Address - Phone:701-212-7575
Mailing Address - Fax:
Practice Address - Street 1:282 N EL CAMINO REAL STE F
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2863
Practice Address - Country:US
Practice Address - Phone:760-634-1957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT35481152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist