Healthcare Provider Details

I. General information

NPI: 1306332630
Provider Name (Legal Business Name): RYAN NGUYEN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 E FLORENCE BLVD STE 2
CASA GRANDE AZ
85122-4842
US

IV. Provider business mailing address

1775 E FLORENCE BLVD STE 2
CASA GRANDE AZ
85122-4842
US

V. Phone/Fax

Practice location:
  • Phone: 520-426-1600
  • Fax:
Mailing address:
  • Phone: 520-426-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-002263
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: