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General NPI Number Information
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NPI Number | 1023782562
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Entity Type | Individual
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Provider Name | PIERRE THANH-KHOA NGUYEN O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/08/2021
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Last Update Date | 08/11/2021
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Provider Practice Location Address
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Address Line | 2055 E WINDMILL LN STE 105
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City | LAS VEGAS
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State | NV
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Zip | 89123-2070
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Country | US
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Telephone | 702-731-2233
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Fax | 702-450-6116
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Provider Business Mailing Address
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Address Line | 5175 JERRY TARKANIAN WAY UNIT 23202
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City | LAS VEGAS
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State | NV
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Zip | 89148-5172
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Country | US
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Telephone | 408-728-2819
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1103
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License Number State | NV
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