MEDICARE: DR. ETHAN LONG HONG NGUYEN OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	11617	TX

General Provider Information

NPI Number	:	1174454821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ETHAN LONG HONG NGUYEN OD

Provider Business Mailing Address
First Line	:	5803 PHEASANT RIDGE LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77041-4202
Country	:	US
Telephone Number	:	713-983-8012
Fax Number	:

Provider Business Practice Location Address
First Line	:	4805 HIGHWAY 6 N STE 12-B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-2716
Country	:	US
Telephone Number	:	281-500-7252
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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