Provider Demographics
NPI:1699403048
Name:NGUYEN, KEVIN NGOC (OD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:NGOC
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 1:16502 AVARANCHE WAY
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5329
Mailing Address - Country:US
Mailing Address - Phone:512-905-5679
Mailing Address - Fax:
Practice Address - Street 1:6464 E NORTHWEST HWY STE 309
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-7808
Practice Address - Country:US
Practice Address - Phone:469-248-0670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10678152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist