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General NPI Number Information
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NPI Number | 1184119513
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Entity Type | Organization
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Legal Business Name | ELLEN NGUYEN OD LLC
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Dates
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Enumeration Date | 06/27/2018
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Last Update Date | 06/27/2018
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Provider Practice Location Address
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Address Line | 4858 HIGHWAY 1
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City | RACELAND
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State | LA
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Zip | 70394-2627
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Country | US
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Telephone | 985-532-3939
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Fax | 985-532-3966
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Provider Business Mailing Address
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Address Line | 6421 AVENUE A
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City | NEW ORLEANS
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State | LA
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Zip | 70124-2144
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Country | US
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Telephone | 504-905-2344
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELLEN NGUYEN
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Credential | OD
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Telephone | 504-905-2377
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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 | 1608638AT
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License Number State | LA
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