Provider Demographics
NPI:1215137732
Name:NGUYEN, ALICE P (OD)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:P
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 1:1215 DEXTER AVE N APT 835
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-3575
Mailing Address - Country:US
Mailing Address - Phone:832-260-6468
Mailing Address - Fax:
Practice Address - Street 1:1701 S COMMONS
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6037
Practice Address - Country:US
Practice Address - Phone:253-941-4980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5096T152W00000X
CA10774152W00000X
WA60063073152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0067FCOtherBLUE CROSS/ BLUE SHIELDS