MEDICARE: TRI NGUYEN O.D.

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	R-298-TA-C19	AL
2	152W00000X	Optometrist	OPC5084	FL

General Provider Information

NPI Number	:	1689057366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRI NGUYEN O.D.

Provider Business Mailing Address
First Line	:	5062 MOBILE HWY
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32506-3240
Country	:	US
Telephone Number	:	850-453-4373
Fax Number	:	850-453-1953

Provider Business Practice Location Address
First Line	:	5062 MOBILE HWY
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32506-3240
Country	:	US
Telephone Number	:	850-453-4373
Fax Number	:	850-453-1953

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

Provider Enumeration Date	:	06/30/2015
Last Update Date	:	05/15/2023

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Directions to “ TRI NGUYEN O.D.” Practice Location

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