Healthcare Provider Details

I. General information

NPI: 1831874577
Provider Name (Legal Business Name): DALENA MICHELLE NGUYEN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3140 LEGACY DR STE 500
FRISCO TX
75034-8340
US

IV. Provider business mailing address

PO BOX 208904
DALLAS TX
75320-8904
US

V. Phone/Fax

Practice location:
  • Phone: 214-619-5580
  • Fax: 214-619-5581
Mailing address:
  • Phone: 636-200-4393
  • Fax: 636-527-0766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10661
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: