Healthcare Provider Details

I. General information

NPI: 1982754214
Provider Name (Legal Business Name): TAM NGUYEN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRANH TAM NGUYEN

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 GREECE RIDGE CENTER DR
ROCHESTER NY
14626-2815
US

IV. Provider business mailing address

82 RIO GRANDE DR
NORTH CHILI NY
14514-9780
US

V. Phone/Fax

Practice location:
  • Phone: 716-227-8580
  • Fax:
Mailing address:
  • Phone: 585-889-3676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberNY6600
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: