MEDICARE: DR. JIMMY TUY 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	OEG-001886	PA

General Provider Information

NPI Number	:	1962420224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIMMY TUY NGUYEN O.D.

Provider Business Mailing Address
First Line	:	243 HAVERFORD RD
Second Line	:
City	:	WYNNEWOOD
State	:	PA
Zip	:	19096-3318
Country	:	US
Telephone Number	:	610-930-3312
Fax Number	:

Provider Business Practice Location Address
First Line	:	2805 W CHESTER PIKE
Second Line	:
City	:	BROOMALL
State	:	PA
Zip	:	19008-1827
Country	:	US
Telephone Number	:	610-356-3933
Fax Number	:	610-356-3324

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	01/12/2012

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