MEDICARE: DR. KIM-THU THI 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	5264T	TX

General Provider Information

NPI Number	:	1932321445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIM-THU THI NGUYEN O.D.

Provider Business Mailing Address
First Line	:	1201 LAKE WOODLANDS DR
Second Line	:	SUITE #2112
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-5000
Country	:	US
Telephone Number	:	281-298-3755
Fax Number	:	281-298-7677

Provider Business Practice Location Address
First Line	:	1201 LAKE WOODLANDS DR
Second Line	:	SUITE #2112
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-5000
Country	:	US
Telephone Number	:	281-298-3755
Fax Number	:	281-298-7677

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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