MEDICARE: PHUONG CELINE 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	2238	AZ

General Provider Information

NPI Number	:	1821585795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHUONG CELINE NGUYEN

Provider Business Mailing Address
First Line	:	4973 E. ROSEMONTE DRIVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-6153
Country	:	US
Telephone Number	:	858-776-2502
Fax Number	:

Provider Business Practice Location Address
First Line	:	7000 E MAYO BLVD STE 1034
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85054-6153
Country	:	US
Telephone Number	:	480-513-3106
Fax Number	:

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

Provider Enumeration Date	:	04/17/2018
Last Update Date	:	04/17/2018

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Directions to “ PHUONG CELINE NGUYEN ” Practice Location

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