Provider Demographics
NPI:1154589067
Name:NGUYEN, JOHN K (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:K
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5619 W LOOP 1604 N STE 114
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5795
Mailing Address - Country:US
Mailing Address - Phone:210-647-0728
Mailing Address - Fax:
Practice Address - Street 1:5619 W LOOP 1604 N STE 114
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-5795
Practice Address - Country:US
Practice Address - Phone:210-492-4188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX6758152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist