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General NPI Number Information
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NPI Number | 1720458805
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Entity Type | Organization
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Legal Business Name | ANN T NGUYEN LLC
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Dates
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Enumeration Date | 10/01/2015
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Last Update Date | 10/01/2015
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Provider Practice Location Address
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Address Line | 824 SW 349TH WAY
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City | FEDERAL WAY
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State | WA
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Zip | 98023-8444
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Country | US
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Telephone | 323-813-6438
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Fax |
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Provider Business Mailing Address
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Address Line | 824 SW 349TH WAY
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City | FEDERAL WAY
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State | WA
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Zip | 98023
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Country | US
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Telephone | 323-813-6438
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | ANN NGUYEN
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Credential | OD
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Telephone | 323-813-6438
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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 | OD60461499
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License Number State | WA
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