MEDICARE: DR. JENNY MY LINH 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	10274	TX

General Provider Information

NPI Number	:	1235876582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNY MY LINH NGUYEN OD

Provider Business Mailing Address
First Line	:	716 WILLINGTON DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76018-5113
Country	:	US
Telephone Number	:	817-917-8430
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 HIGHWAY 287 N
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-8852
Country	:	US
Telephone Number	:	682-518-1177
Fax Number	:	682-518-8889

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

Provider Enumeration Date	:	05/18/2022
Last Update Date	:	05/18/2022

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