MEDICARE: MINH-TAM NGUYEN

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	OEG003247	PA
2	152W00000X	Optometrist	0618002638	VA
3	152W00000X	Optometrist	TA2628	MD

General Provider Information

NPI Number	:	1093253247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINH-TAM NGUYEN

Provider Business Mailing Address
First Line	:	8424 OLD KEENE MILL RD
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-2302
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8424 OLD KEENE MILL RD
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-2302
Country	:	US
Telephone Number	:	703-569-6611
Fax Number	:

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

Provider Enumeration Date	:	02/08/2017
Last Update Date	:	09/25/2020

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Directions to “ MINH-TAM NGUYEN ” Practice Location

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