MEDICARE: ANNY NGUYEN O.D. PLLC

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	7727TG	TX

General Provider Information

NPI Number	:	1407394067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANNY NGUYEN O.D. PLLC

Provider Business Mailing Address
First Line	:	3460 W FM 544 STE 550
Second Line	:
City	:	WYLIE
State	:	TX
Zip	:	75098-9408
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7805 N MACARTHUR BLVD STE 101
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-7531
Country	:	US
Telephone Number	:	972-496-0839
Fax Number	:	214-496-0841

Authorized Official
Title or Position	:	PRESIDENT/OPTOMETRIST
Name	:	ANNY NGUYEN
Credential	:	O.D.
Telephone Number	:	469-585-4398

Provider Enumeration Date	:	02/03/2017
Last Update Date	:	02/03/2017

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