MEDICARE: DR. ELIZABETH T 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	6947T	TX

General Provider Information

NPI Number	:	1699817635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH T NGUYEN O.D.

Provider Business Mailing Address
First Line	:	8202 N LOOP 1604 W
Second Line	:	STE 105
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2897
Country	:	US
Telephone Number	:	210-691-4733
Fax Number	:	210-691-3322

Provider Business Practice Location Address
First Line	:	8202 N LOOP 1604 W
Second Line	:	STE 105
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2897
Country	:	US
Telephone Number	:	210-691-4733
Fax Number	:

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/30/2019

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