Provider Demographics
NPI:1982271565
Name:TRACY NGO OD, INC.
Entity type:Organization
Organization Name:TRACY NGO OD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:YEN-KHANH
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-662-1171
Mailing Address - Street 1:39864 SWEETBRIER CIR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-6160
Mailing Address - Country:US
Mailing Address - Phone:954-662-1171
Mailing Address - Fax:951-723-1221
Practice Address - Street 1:30340 HAUN RD
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-6806
Practice Address - Country:US
Practice Address - Phone:951-723-1224
Practice Address - Fax:951-723-1221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty