Individual provider Active NPI

Mai Nguyen

  • Optometrist
  • Riverside, CA
National Provider Identifier
1730721739
Registry record updated Oct 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
34366TLG Issued in CA
Practice address
3824 La Sierra Ave
Riverside, CA 92505-3528
Phone
(951) 359-3377
NPI assigned
Oct 10, 2019
Last updated
Oct 10, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 34366TLG CA Primary

Addresses

Primary practice location

3824 La Sierra Ave
Riverside, CA 92505-3528

Mailing address

2021 S Reservoir St
Pomona, CA 91766-5546

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200831000844 CA Practitioner - Optometry 9032536487 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

15070 Summit Ave
Suite 400
Fontana, CA 92336-5496
Phone (909) 538-9246

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34366TLGCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Mai Nguyen, O.D., Optometric Corporation Optometrist CurrentSince Feb 1, 2025 Accepting new patients
Trung V. Tran, OD Optometric Corporation Optometrist CurrentSince Oct 13, 2019 Accepting new patients
Al Vincent D Romero O D Inc Optometrist PastSince Oct 13, 2019 Accepting new patients
Total Vision PC Optometrist Past Accepting new patients

Locations

15070 Summit Ave
Ste 400
Fontana, CA 92336
Phone (909) 463-4655

3824 La Sierra Ave
Riverside, CA 92505
Phone (909) 359-3377

Organizations & group practices 4

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": "1570665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570665600000",
    "number": "1730721739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2021 S RESERVOIR ST",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917665546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3824 LA SIERRA AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925053528",
            "telephone_number": "951-359-3377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "MAI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-10",
        "last_updated": "2019-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "34366TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.