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NPI Code Detail

MEDICARE: MONICA DIEM PHUONG NGUYEN O.D.

MEDICARE:   MONICA DIEM PHUONG 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
1152W00000XOptometrist5059MA

General Provider Information

NPI Number : 1134475502
Entity Type Code : Individual
Provider Name (Legal Business Name) : MONICA DIEM PHUONG NGUYEN O.D.
Provider Business Mailing Address
First Line : 12 REVERE PL
Second Line :
City : MEDFORD
State : MA
Zip : 02155-3903
Country : US
Telephone Number : 225-284-6030
Fax Number :
Provider Business Practice Location Address
First Line : 1340 BOYLSTON ST # 6F
Second Line :
City : BOSTON
State : MA
Zip : 02215-4302
Country : US
Telephone Number : 617-927-6190
Fax Number : 617-236-4262
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2012
Last Update Date : 07/26/2021

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Directions to “ MONICA DIEM PHUONG NGUYEN O.D.” Practice Location

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