Healthcare Provider Details

I. General information

NPI: 1699111518
Provider Name (Legal Business Name): MYLEE NGUYEN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2013
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18920 BOTHELL WAY NE SUITE 203
BOTHELL WA
98011-1981
US

IV. Provider business mailing address

18920 BOTHELL WAY NE
BOTHELL WA
98011-1981
US

V. Phone/Fax

Practice location:
  • Phone: 425-213-1016
  • Fax: 425-949-4491
Mailing address:
  • Phone: 425-213-1016
  • Fax: 425-949-4491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD.OD.60374410
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: