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NPI Code Detail

MEDICARE: THU THI NGUYEN O.D.

MEDICARE: THU THI 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
1152W00000XOptometrist14274CA

General Provider Information

NPI Number : 1326323627
Entity Type Code : Individual
Provider Name (Legal Business Name) : THU THI NGUYEN O.D.
Provider Business Mailing Address
First Line : 6126 DAISY PL
Second Line :
City : SAN DIEGO
State : CA
Zip : 92114-6612
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4840 SHAWLINE ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92111-1400
Country : US
Telephone Number : 858-560-5742
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2011
Last Update Date : 01/08/2025

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