Healthcare Provider Details

I. General information

NPI: 1699772616
Provider Name (Legal Business Name): LINDA NGUYEN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 PAA ST
KAHULUI HI
96732-3605
US

IV. Provider business mailing address

32 PAA ST
KAHULUI HI
96732-3605
US

V. Phone/Fax

Practice location:
  • Phone: 808-877-7828
  • Fax: 808-442-9764
Mailing address:
  • Phone: 808-877-7828
  • Fax: 808-442-9746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number633
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: