MEDICARE: DR. MAIPHUONG NGUYEN

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	5742T	TX

General Provider Information

NPI Number	:	1548289606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAIPHUONG NGUYEN

Provider Business Mailing Address
First Line	:	17428 W GRAND PKWY S
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-2564
Country	:	US
Telephone Number	:	281-342-1000
Fax Number	:	281-342-1002

Provider Business Practice Location Address
First Line	:	17428 W GRAND PKWY S
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-2564
Country	:	US
Telephone Number	:	281-342-1000
Fax Number	:	281-342-1002

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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