Provider Demographics
NPI:1194347674
Name:NGUYEN, KATHY THU QUYNH (OD)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:THU QUYNH
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 1:5821 S SPRAGUE CT
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-6903
Mailing Address - Country:US
Mailing Address - Phone:253-396-4200
Mailing Address - Fax:253-396-4226
Practice Address - Street 1:5821 S SPRAGUE CT
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-6903
Practice Address - Country:US
Practice Address - Phone:253-396-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD61056552152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist