MEDICARE: DR. QUAN MANH 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	8027T	TX

General Provider Information

NPI Number	:	1144584400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. QUAN MANH NGUYEN O.D.

Provider Business Mailing Address
First Line	:	10080 BELLAIRE BLVD STE 105
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-5249
Country	:	US
Telephone Number	:	713-774-3211
Fax Number	:	713-774-2310

Provider Business Practice Location Address
First Line	:	10080 BELLAIRE BLVD STE 105
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-5249
Country	:	US
Telephone Number	:	713-774-3211
Fax Number	:	713-774-2310

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

Provider Enumeration Date	:	07/01/2012
Last Update Date	:	09/23/2021

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