Provider Demographics
NPI:1528169711
Name:NGUYEN, YEN HOANG (OD)
Entity type:Individual
Prefix:DR
First Name:YEN
Middle Name:HOANG
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 1:1950 OLD GALLOWS RD
Mailing Address - Street 2:SUITE 520
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3990
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:703-991-0514
Practice Address - Street 1:499 SE GREENVILLE BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-6734
Practice Address - Country:US
Practice Address - Phone:252-756-9404
Practice Address - Fax:252-756-6519
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2037152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC093VPOtherBCBS PROV #
NC5905665Medicaid
NC093VPOtherBCBS PROV #
NC2474230AMedicare PIN
V11353Medicare UPIN