MEDICARE: DAT NGUYEN OD 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	7469TG	TX

General Provider Information

NPI Number	:	1710329727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAT NGUYEN OD PLLC

Provider Business Mailing Address
First Line	:	7111 MARVIN D LOVE FWY STE 101
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-3112
Country	:	US
Telephone Number	:	972-298-5379
Fax Number	:	972-842-7668

Provider Business Practice Location Address
First Line	:	7111 MARVIN D LOVE FWY STE 101
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-3112
Country	:	US
Telephone Number	:	972-298-5379
Fax Number	:	972-842-7668

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DAT NGUYEN
Credential	:	OD
Telephone Number	:	972-298-5379

Provider Enumeration Date	:	07/19/2013
Last Update Date	:	10/22/2016

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