Provider Demographics
NPI:1316253933
Name:NGUYEN, NGA PHUONG (OD)
Entity type:Individual
Prefix:DR
First Name:NGA
Middle Name:PHUONG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:10115 PALERMO CIR
Mailing Address - Street 2:103
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-5079
Mailing Address - Country:US
Mailing Address - Phone:352-328-4772
Mailing Address - Fax:
Practice Address - Street 1:400 E DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3866
Practice Address - Country:US
Practice Address - Phone:181-387-4872
Practice Address - Fax:813-877-3420
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOPC4537152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist