Provider Demographics
NPI:1427021682
Name:NGUYEN, HIEN (OD)
Entity type:Individual
Prefix:DR
First Name:HIEN
Middle Name:
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 1:6651 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-5194
Mailing Address - Country:US
Mailing Address - Phone:804-694-4999
Mailing Address - Fax:804-694-4999
Practice Address - Street 1:6651 MAIN ST
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-5194
Practice Address - Country:US
Practice Address - Phone:804-694-4999
Practice Address - Fax:804-694-4999
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000951152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1427021682Medicaid
VAV04113Medicare UPIN