MEDICARE: DR. JACQUELINE 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	10667	TX

General Provider Information

NPI Number	:	1972236180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE NGUYEN O.D.

Provider Business Mailing Address
First Line	:	15914 BISHOPS GLEN LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-7531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5290 BELT LINE RD STE 102B
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-7544
Country	:	US
Telephone Number	:	214-983-9528
Fax Number	:

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

Provider Enumeration Date	:	07/05/2022
Last Update Date	:	04/21/2025

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