Healthcare Provider Details

I. General information

NPI: 1255302477
Provider Name (Legal Business Name): DIANA THI NGUYEN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DIANA THI NGUYEN O.D.

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 MCCREE RD
DALLAS TX
75238-3275
US

IV. Provider business mailing address

8013 STILL SPRINGS DR
PLANO TX
75025-3947
US

V. Phone/Fax

Practice location:
  • Phone: 214-341-0422
  • Fax: 241-341-0422
Mailing address:
  • Phone: 214-341-0422
  • Fax: 214-341-0422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number5349T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: