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General NPI Number Information
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NPI Number | 1699084442
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Entity Type | Individual
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Provider Name | THERESE ANNE VY-PHUC THUY NGUYEN O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/28/2010
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 3350 LA JOLLA VILLAGE DR
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City | SAN DIEGO
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State | CA
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Zip | 92161-1207
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Country | US
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Telephone | 858-552-8585
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Fax |
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Provider Business Mailing Address
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Address Line | 7055 PARK MESA WAY UNIT 151
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City | SAN DIEGO
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State | CA
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Zip | 92111-5663
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Country | US
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Telephone | 626-344-0413
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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 | 14040
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License Number State | CA
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