=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770037129
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. BACH NGUYEN, O.D. AND ASSOCIATES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2016
-----------------------------------------------------
Last Update Date | 08/15/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6155 EASTEX FWY STE 699
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77706-6718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-571-8350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17307 KLEE CIR
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77379-6264
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BACH NGUYEN
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 512-571-8350
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 8951T
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------