MEDICARE: DR. THERESA BOI NGOC 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	152WC0802X	Corneal and Contact Management Optometrist	35123	CA
2	152W00000X	Optometrist	35123	CA

General Provider Information

NPI Number	:	1437896180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESA BOI NGOC NGUYEN OD

Provider Business Mailing Address
First Line	:	105 SPROUL CT
Second Line	:
City	:	MERCED
State	:	CA
Zip	:	95348-8564
Country	:	US
Telephone Number	:	408-568-6585
Fax Number	:

Provider Business Practice Location Address
First Line	:	3178 COLLINS DR STE A
Second Line	:
City	:	MERCED
State	:	CA
Zip	:	95348-3155
Country	:	US
Telephone Number	:	209-383-1246
Fax Number	:

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

Provider Enumeration Date	:	05/15/2022
Last Update Date	:	05/15/2022

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