Healthcare Provider Details

I. General information

NPI: 1528477221
Provider Name (Legal Business Name): MVN CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8621 OHIO DR
PLANO TX
75024-2264
US

IV. Provider business mailing address

8621 OHIO DR
PLANO TX
75024-2264
US

V. Phone/Fax

Practice location:
  • Phone: 214-872-4404
  • Fax: 214-872-4403
Mailing address:
  • Phone: 214-872-4404
  • Fax: 214-872-4403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7388T
License Number StateTX

VIII. Authorized Official

Name: MINH V NGUYEN
Title or Position: THERAPEUTIC OPTOMETRIST
Credential: O.D.
Phone: 512-762-9523