Provider Demographics
NPI:1194737916
Name:NGUYEN, TUAN TU (OD)
Entity type:Individual
Prefix:DR
First Name:TUAN
Middle Name:TU
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 1:929 NE 181ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-6757
Mailing Address - Country:US
Mailing Address - Phone:503-669-1992
Mailing Address - Fax:503-618-8262
Practice Address - Street 1:1274 SE 182ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233
Practice Address - Country:US
Practice Address - Phone:503-669-1992
Practice Address - Fax:503-618-8262
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2987T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V07577Medicare UPIN
133449Medicare ID - Type Unspecified