MEDICARE: DR. VICKI THUY VY NGUYEN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	9036T	TX

General Provider Information

NPI Number	:	1063863454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICKI THUY VY NGUYEN O.D.

Provider Business Mailing Address
First Line	:	1650 HIGHWAY 287 N
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063
Country	:	US
Telephone Number	:	682-518-1177
Fax Number	:	682-518-8889

Provider Business Practice Location Address
First Line	:	1650 HIGHWAY 287 N
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-8852
Country	:	US
Telephone Number	:	682-518-1177
Fax Number	:	682-518-8889

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2016
Last Update Date	:	06/27/2016

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