Provider Demographics
NPI:1063579688
Name:NGUYEN, NGOC-THUY TRINA (OD)
Entity type:Individual
Prefix:DR
First Name:NGOC-THUY
Middle Name:TRINA
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 1:20470 VIA CELESTINA
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-3145
Mailing Address - Country:US
Mailing Address - Phone:714-693-1733
Mailing Address - Fax:714-693-1739
Practice Address - Street 1:10872 WESTMINSTER AVE
Practice Address - Street 2:STE 112
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4981
Practice Address - Country:US
Practice Address - Phone:714-636-9585
Practice Address - Fax:714-636-2465
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9686T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA167250OtherHIGH MARK
CASD0096861Medicaid
CA114158OtherEYE MED
CA12374OtherMEDICAL EYE SERVICES
CA07626OtherSPECTERA
CA35995OtherDAVIS VISION
CAOP9686Medicare ID - Type Unspecified