Provider Demographics
NPI:1326444639
Name:NGUYEN, QUAN ANH NGOC (OD)
Entity type:Individual
Prefix:DR
First Name:QUAN ANH
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23291 SAND CANYON CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-5085
Mailing Address - Country:US
Mailing Address - Phone:951-454-9782
Mailing Address - Fax:
Practice Address - Street 1:1800 N PERRIS BLVD
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-2701
Practice Address - Country:US
Practice Address - Phone:951-561-0137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-13
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15152152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist