Provider Demographics
NPI:1588911739
Name:NGUYEN, MYLOAN THI (OD)
Entity type:Individual
Prefix:DR
First Name:MYLOAN
Middle Name:THI
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 1:17059 S BRANDT ST
Mailing Address - Street 2:3108
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-7202
Mailing Address - Country:US
Mailing Address - Phone:240-938-0519
Mailing Address - Fax:
Practice Address - Street 1:502 W MARKET ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-2322
Practice Address - Country:US
Practice Address - Phone:302-856-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEI3-0001361152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist