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General NPI Number Information
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NPI Number | 1649505801
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Entity Type | Organization
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Legal Business Name | DYNAMIC EYECARE PA
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Dates
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Enumeration Date | 10/06/2009
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Last Update Date | 08/09/2011
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Provider Practice Location Address
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Address Line | 9598 ROWLETT RD
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City | HOUSTON
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State | TX
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Zip | 77075-2414
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Country | US
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Telephone | 713-947-3771
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Fax | 713-947-3772
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Provider Business Mailing Address
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Address Line | 11710 DUMAS ST
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City | HOUSTON
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State | TX
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Zip | 77034-3694
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Country | US
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Telephone | 713-947-3771
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Fax | 713-947-3772
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLIE HUY NGUYEN
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Credential | O.D.
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Telephone | 832-282-2182
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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 | 06780TG
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License Number State | TX
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