Healthcare Provider Details

I. General information

NPI: 1275591950
Provider Name (Legal Business Name): HANH MAI NGUYEN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 BIRDSONG DR STE A
BAYTOWN TX
77521-3771
US

IV. Provider business mailing address

21502 MERCHANTS WAY STE A
KATY TX
77449-2515
US

V. Phone/Fax

Practice location:
  • Phone: 281-422-2020
  • Fax: 281-422-4959
Mailing address:
  • Phone: 281-944-2232
  • Fax: 281-944-2290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5793TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: