=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063691418
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAO-TRAN NGUYEN O.D P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2007
-----------------------------------------------------
Last Update Date | 11/01/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 455 GREENSPOINT MALL
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77060-1815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-248-4565
-----------------------------------------------------
Fax | 281-248-4472
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 455 GREENSPOINT MALL
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77060-1815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-248-4565
-----------------------------------------------------
Fax | 281-248-4472
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BAO-TRAN DINH NGUYEN
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 281-248-4565
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 6235
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------