Provider Demographics
NPI:1487703427
Name:NGUYEN, KATELYN TERESE (OD)
Entity type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:TERESE
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 1:128 GALLERY WAY
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1109
Mailing Address - Country:US
Mailing Address - Phone:714-931-4268
Mailing Address - Fax:
Practice Address - Street 1:10920 GARFIELD AVE STE A2
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-7502
Practice Address - Country:US
Practice Address - Phone:562-861-9098
Practice Address - Fax:562-861-9533
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12503152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist