Healthcare Provider Details

I. General information

NPI: 1942314943
Provider Name (Legal Business Name): HOA THI NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 W PARK BLVD SUITE C216
PLANO TX
75093-6221
US

IV. Provider business mailing address

1509 DUTCHMAN CREEK DR
DESOTO TX
75115-3661
US

V. Phone/Fax

Practice location:
  • Phone: 972-400-5522
  • Fax:
Mailing address:
  • Phone: 713-502-8428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6917TG
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number6917TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: