MEDICARE: DR. GARY NGOC 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	05813T	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11616015	OTHER	TX	CAQH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356375752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY NGOC NGUYEN O.D.

Provider Business Mailing Address
First Line	:	5601 WASHINGTON AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-5134
Country	:	US
Telephone Number	:	832-319-7732
Fax Number	:	832-319-7737

Provider Business Practice Location Address
First Line	:	5601 WASHINGTON AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-5134
Country	:	US
Telephone Number	:	832-319-7732
Fax Number	:	832-319-7737

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	11/05/2015

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