=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871783258
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRAM DANG NGUYEN O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2007
-----------------------------------------------------
Last Update Date | 09/30/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 811 N CENTRAL EXPY
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75075-8815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-516-0026
-----------------------------------------------------
Fax | 972-516-0609
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 811 N CENTRAL EXPY
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75075-8815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-516-0026
-----------------------------------------------------
Fax | 972-516-0609
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 7684T
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2593
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 3180-35
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------