Healthcare Provider Details

I. General information

NPI: 1205766466
Provider Name (Legal Business Name): LAN NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 N BRADLEY ST
WEATHERFORD OK
73096-5229
US

IV. Provider business mailing address

11217 SW 30TH ST
YUKON OK
73099-1164
US

V. Phone/Fax

Practice location:
  • Phone: 580-772-3232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3360
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: