MEDICARE: DR. KATTY NGUYEN OD

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	OPC6102	FL

General Provider Information

NPI Number	:	1144951591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATTY NGUYEN OD

Provider Business Mailing Address
First Line	:	220 SE 2ND ST APT 2307
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-4277
Country	:	US
Telephone Number	:	508-685-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	9370 6 MILE CYPRESS PKWY STE 4
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-6506
Country	:	US
Telephone Number	:	508-685-2800
Fax Number	:

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

Provider Enumeration Date	:	06/17/2022
Last Update Date	:	07/28/2022

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