Healthcare Provider Details

I. General information

NPI: 1528098415
Provider Name (Legal Business Name): NGUYEN WATERMAN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 VARNUM ST NE STE 11
WASHINGTON DC
20017-2110
US

IV. Provider business mailing address

2002 MEDICAL PKWY STE 320
ANNAPOLIS MD
21401-7901
US

V. Phone/Fax

Practice location:
  • Phone: 202-529-5200
  • Fax:
Mailing address:
  • Phone: 410-571-8733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6520T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: