Provider Demographics
NPI:1699973438
Name:NGUYEN, TAM (OD, MS)
Entity type:Individual
Prefix:
First Name:TAM
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 BLEECKER ST
Mailing Address - Street 2:UNIT 724
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-1547
Mailing Address - Country:US
Mailing Address - Phone:617-347-3465
Mailing Address - Fax:
Practice Address - Street 1:45 RIVINGTON ST
Practice Address - Street 2:EYE CLINIC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-1304
Practice Address - Country:US
Practice Address - Phone:617-347-3465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007248-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03596889Medicaid