Healthcare Provider Details

I. General information

NPI: 1013560333
Provider Name (Legal Business Name): NHI THI TUYET NGUYEN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 N MERIDIAN STREET
INDIANAPOLIS IN
46202-1303
US

IV. Provider business mailing address

1901 N MERIDIAN STREET
INDIANAPOLIS IN
46202-1303
US

V. Phone/Fax

Practice location:
  • Phone: 317-925-2200
  • Fax: 317-921-0886
Mailing address:
  • Phone: 317-925-2200
  • Fax: 317-921-0886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18004169A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: