MEDICARE: DR. NGUYEN WATERMAN 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	6520T	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6520TG	OTHER	TX	TEXAS OPTOMETRY BOARD
2	1619	OTHER	SC	STATE LICENSE

General Provider Information

NPI Number	:	1528098415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NGUYEN WATERMAN O.D.

Provider Business Mailing Address
First Line	:	2002 MEDICAL PKWY STE 320
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-7901
Country	:	US
Telephone Number	:	410-571-8733
Fax Number	:

Provider Business Practice Location Address
First Line	:	1160 VARNUM ST NE STE 11
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20017-2110
Country	:	US
Telephone Number	:	202-529-5200
Fax Number	:

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	03/12/2024

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