Active NPI
Shannon Phuong Nguyen, O.D.
- Optometrist
- Stanton, CA
National Provider Identifier
1346233954
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 12487T
- Practice address
- 12107 Beach Blvd
Stanton, CA 90680-3706 - Phone
- (714) 373-5201
- Fax
- (714) 373-5201
- NPI assigned
- Aug 30, 2005
- Last updated
- Feb 5, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 12487T | CA | Primary |
Addresses
Primary practice location
12107 Beach Blvd
Stanton, CA 90680-3706
Mailing address
12107 Beach Blvd
Stanton, CA 90680-3706
Phone (714) 373-5201
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12487T | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Luxottica of America Inc. | Past | Accepting new patients | |
| Luxottica of America Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360022400000",
"number": "1346233954",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12107 BEACH BLVD",
"city": "STANTON",
"state": "CA",
"postal_code": "906803706",
"telephone_number": "714-373-5201",
"fax_number": "714-373-5201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12107 BEACH BLVD",
"city": "STANTON",
"state": "CA",
"postal_code": "906803706",
"telephone_number": "714-373-5201",
"fax_number": "714-373-5201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NGUYEN",
"first_name": "SHANNON",
"middle_name": "PHUONG",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-08-30",
"last_updated": "2013-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "12487T",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stanton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.