Provider Demographics
NPI:1992086821
Name:NGUYEN, THAI-AN (OD)
Entity type:Individual
Prefix:DR
First Name:THAI-AN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:THAI-AN
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD PLLC
Mailing Address - Street 1:2634 S CARRIER PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-5005
Mailing Address - Country:US
Mailing Address - Phone:972-641-0011
Mailing Address - Fax:972-641-8206
Practice Address - Street 1:2634 S CARRIER PKWY STE 101
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-5005
Practice Address - Country:US
Practice Address - Phone:972-641-0011
Practice Address - Fax:972-641-8206
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7739TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1992086821OtherAETNA
TX341422Medicare PIN
TXTXB143014Medicare PIN