=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720410459
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THI KHOA NGUYEN OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2013
-----------------------------------------------------
Last Update Date | 02/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6301 W PARMER LN STE 604
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78729-6807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-953-8178
-----------------------------------------------------
Fax | 512-521-0666
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6301 W PARMER LN STE 604
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78729-6807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-953-8178
-----------------------------------------------------
Fax | 512-521-0666
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 8259
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------