=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235394214
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIRECT EYECARE P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2008
-----------------------------------------------------
Last Update Date | 07/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12630 HUFFMEISTER RD
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77429-3229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-382-1942
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12630 HUFFMEISTER RD
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77429-3229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. JENNY H. NGUYEN
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 713-382-1942
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 7038T
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------