Provider Demographics
NPI:1427299635
Name:NGUYEN, THI (OD)
Entity type:Individual
Prefix:MISS
First Name:THI
Middle Name:
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 1:1429 CADDO ST
Mailing Address - Street 2:APT D
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-5212
Mailing Address - Country:US
Mailing Address - Phone:972-387-3937
Mailing Address - Fax:972-387-0606
Practice Address - Street 1:4948 GULFSTREAM DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-7632
Practice Address - Country:US
Practice Address - Phone:972-387-3937
Practice Address - Fax:972-387-0606
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX07094TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist