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General NPI Number Information
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NPI Number | 1710338819
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Entity Type | Individual
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Provider Name | BACH NGUYEN O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/29/2016
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 837 S CLEARVIEW PKWY
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City | JEFFERSON
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State | LA
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Zip | 70121-3119
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Country | US
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Telephone | 504-733-0406
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 79591
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City | BALTIMORE
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State | MD
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Zip | 21279-0591
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Country | US
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Telephone | 703-847-8899
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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 | 2055-001AT
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License Number State | LA
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