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General NPI Number Information
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NPI Number | 1073008058
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Entity Type | Individual
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Provider Name | RYAN NGUYEN OD
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Gender | Male
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Dates
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Enumeration Date | 06/22/2018
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Last Update Date | 08/23/2019
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Provider Practice Location Address
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Address Line | 5222 N CLARK ST
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City | CHICAGO
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State | IL
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Zip | 60640-2377
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Country | US
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Telephone | 773-275-2538
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Fax |
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Provider Business Mailing Address
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Address Line | 5222 N CLARK ST
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City | CHICAGO
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State | IL
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Zip | 60640-2377
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Country | US
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Telephone | 773-275-2538
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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 | OFC87
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV008816
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT34192
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 046.011354
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License Number State | IL
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