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General NPI Number Information
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NPI Number | 1659082865
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Entity Type | Individual
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Provider Name | QUANG NGUYEN OD
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Gender | Male
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Dates
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Enumeration Date | 12/08/2022
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Last Update Date | 12/08/2022
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Provider Practice Location Address
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Address Line | 1971 HIGHWAY 287 N STE 105
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City | MANSFIELD
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State | TX
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Zip | 76063-8983
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Country | US
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Telephone | 817-453-7591
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Fax |
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Provider Business Mailing Address
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Address Line | 1775 STATE HIGHWAY 26 APT 1213
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City | GRAPEVINE
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State | TX
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Zip | 76051-2166
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Country | US
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Telephone |
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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 | 10761
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License Number State | TX
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