MEDICARE: GABRIELLE 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	10553	TX

General Provider Information

NPI Number	:	1467189050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLE NGUYEN OD

Provider Business Mailing Address
First Line	:	8614 WESTWOOD CENTER DR FL 9
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-2442
Country	:	US
Telephone Number	:	703-847-8899
Fax Number	:	571-223-6780

Provider Business Practice Location Address
First Line	:	1650 N LAKE FOREST DR STE 100
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-7668
Country	:	US
Telephone Number	:	972-369-1411
Fax Number	:	972-369-1197

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

Provider Enumeration Date	:	08/03/2022
Last Update Date	:	09/07/2022

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