Provider Demographics
NPI:1124470281
Name:NGUYEN, AMY MARIA (OD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIA
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 1:8320 QUAIL SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-8141
Mailing Address - Country:US
Mailing Address - Phone:916-761-4802
Mailing Address - Fax:
Practice Address - Street 1:8320 QUAIL SPRINGS WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95829-8141
Practice Address - Country:US
Practice Address - Phone:916-761-4802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33480152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist