=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992760490
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEVE N. NGUYEN, O.D,, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2006
-----------------------------------------------------
Last Update Date | 10/29/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2811 S HAMPTON RD SUITE B
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75224-2329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-333-2020
-----------------------------------------------------
Fax | 214-333-7316
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2811 S HAMPTON RD SUITE B
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75224-2329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-333-2020
-----------------------------------------------------
Fax | 214-333-7316
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. STEVE N. NGUYEN
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 214-333-2020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 5438TG
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------