Provider Demographics
NPI:1093538324
Name:MAI NGUYEN, O.D., OPTOMETRIC CORPORATION
Entity type:Organization
Organization Name:MAI NGUYEN, O.D., OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAI
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:909-538-9246
Mailing Address - Street 1:11520 SOLAIRE WAY
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-7226
Mailing Address - Country:US
Mailing Address - Phone:909-538-9246
Mailing Address - Fax:
Practice Address - Street 1:15070 SUMMIT AVE STE 400
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-5496
Practice Address - Country:US
Practice Address - Phone:909-538-9246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty