=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093149494
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NGHIEM DINH O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2013
-----------------------------------------------------
Last Update Date | 01/01/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10990 HARBOR HILL DR
-----------------------------------------------------
City | GIG HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98332-8945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-673-3319
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10990 HARBOR HILL DR
-----------------------------------------------------
City | GIG HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98332-8945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-853-8613
-----------------------------------------------------
Fax | 253-853-8614
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OD60511809
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------