Healthcare Provider Details

I. General information

NPI: 1801069810
Provider Name (Legal Business Name): NGUYEN VISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6849 OLD DOMINION DR SUITE 300
MC LEAN VA
22101-3724
US

IV. Provider business mailing address

6849 OLD DOMINION DR SUITE 300
MC LEAN VA
22101-3724
US

V. Phone/Fax

Practice location:
  • Phone: 703-442-0522
  • Fax: 703-442-0525
Mailing address:
  • Phone: 703-442-0522
  • Fax: 703-442-0525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number0618-000735
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number0618-000735
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number0618-000735
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618-000735
License Number StateVA

VIII. Authorized Official

Name: DR. DUC QUI NGUYEN
Title or Position: DIRECTOR
Credential: O.D.
Phone: 703-442-0522