Healthcare Provider Details

I. General information

NPI: 1972915668
Provider Name (Legal Business Name): TRAN HOANG NGUYEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA NGUYEN D.O.

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4337 TERAVISTA CLUB DR STE 100
ROUND ROCK TX
78665-1647
US

IV. Provider business mailing address

4337 TERAVISTA CLUB DR STE 100
ROUND ROCK TX
78665-1647
US

V. Phone/Fax

Practice location:
  • Phone: 512-244-7200
  • Fax: 512-868-3907
Mailing address:
  • Phone: 122-447-2005
  • Fax: 512-868-3907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number69142-21
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: