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General NPI Number Information
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NPI Number | 1548576671
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Entity Type | Individual
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Provider Name | THU TRANG THI NGUYEN O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/26/2010
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Last Update Date | 10/28/2010
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Provider Practice Location Address
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Address Line | 970 NW EASTMAN PKWY
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City | GRESHAM
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State | OR
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Zip | 97030-5533
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Country | US
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Telephone | 503-666-7703
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Fax |
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Provider Business Mailing Address
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Address Line | 3009 NE 165TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98682-8681
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Country | US
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Telephone | 360-433-9872
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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 | 60167666
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License Number State | WA
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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 | 3364AT
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License Number State | OR
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