Provider Demographics
NPI:1073035028
Name:NGO, RYAN TUAN QUY (OD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:TUAN QUY
Last Name:NGO
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 1:651 DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1501
Mailing Address - Country:US
Mailing Address - Phone:415-429-2009
Mailing Address - Fax:415-523-3212
Practice Address - Street 1:651 DIVISADERO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1501
Practice Address - Country:US
Practice Address - Phone:415-429-2009
Practice Address - Fax:415-523-3212
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008663152W00000X
CA37458TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist