Healthcare Provider Details

I. General information

NPI: 1558746511
Provider Name (Legal Business Name): THUY-NGA NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 US HIGHWAY 27 N
SEBRING FL
33870-1691
US

IV. Provider business mailing address

2075 S WILLOW ST
MANCHESTER NH
03103-2305
US

V. Phone/Fax

Practice location:
  • Phone: 863-382-2020
  • Fax: 863-382-1410
Mailing address:
  • Phone: 603-644-6100
  • Fax: 603-314-0405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0916
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618002435
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC5560
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: