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General NPI Number Information
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NPI Number | 1457575128
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Entity Type | Individual
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Provider Name | LOAN THU NGUYEN O.D.
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Gender | Female
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5500 THOMASVILLE RD
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City | TALLAHASSEE
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State | FL
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Zip | 32312-3814
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Country | US
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Telephone | 850-668-1427
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Fax | 850-668-9151
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Provider Business Mailing Address
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Address Line | PO BOX 15722
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City | TALLAHASSEE
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State | FL
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Zip | 32317-5722
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Country | US
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Telephone | 850-284-7344
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Fax | 850-553-4000
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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 | OPC 3660
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License Number State | FL
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