Provider Demographics
NPI:1528517695
Name:NGUYEN, JOHN DAT (OD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DAT
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:2025 PLAMERA LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-2138
Mailing Address - Country:US
Mailing Address - Phone:817-576-4419
Mailing Address - Fax:817-576-4632
Practice Address - Street 1:1732 PRECINCT LINE RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3165
Practice Address - Country:US
Practice Address - Phone:817-576-4419
Practice Address - Fax:817-576-4632
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-29
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2147152W00000X
TX9390T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist