Provider Demographics
NPI:1962420224
Name:NGUYEN, JIMMY TUY (OD)
Entity type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:TUY
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 1:243 HAVERFORD RD
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3318
Mailing Address - Country:US
Mailing Address - Phone:610-930-3312
Mailing Address - Fax:
Practice Address - Street 1:2805 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-1827
Practice Address - Country:US
Practice Address - Phone:610-356-3933
Practice Address - Fax:610-356-3324
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG-001886152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist