MEDICARE: NIKI N 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	11186	TX

General Provider Information

NPI Number	:	1205677648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKI N NGUYEN OD

Provider Business Mailing Address
First Line	:	9091 FAIR OAKS PKWY STE 306
Second Line	:
City	:	FAIR OAKS RANCH
State	:	TX
Zip	:	78015-4690
Country	:	US
Telephone Number	:	210-698-6393
Fax Number	:	210-698-9788

Provider Business Practice Location Address
First Line	:	9091 FAIR OAKS PKWY STE 306
Second Line	:
City	:	FAIR OAKS RANCH
State	:	TX
Zip	:	78015-4690
Country	:	US
Telephone Number	:	210-698-6393
Fax Number	:	210-698-9788

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

Provider Enumeration Date	:	05/31/2024
Last Update Date	:	05/31/2024

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