Healthcare Provider Details

I. General information

NPI: 1578481214
Provider Name (Legal Business Name): DYLAN HUY NGUYEN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10770 N 46TH ST
TAMPA FL
33617-3442
US

IV. Provider business mailing address

8900 95TH ST
SEMINOLE FL
33777-2522
US

V. Phone/Fax

Practice location:
  • Phone: 813-816-7150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.0004234
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: