MEDICARE: DR. KRYSTAL T 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	OEG000225	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2308658000	OTHER		KEYSTONE HLTH PLAN E & PE
2	0181497000	OTHER		KEYSTONE HLTH PLAN E & PE
3	3548372	OTHER	PA	AETNA GROUP
4	1626663	OTHER	PA	BCBS
5	D28112	OTHER		BCBS
6	3550323	OTHER		AETNA IND

General Provider Information

NPI Number	:	1538109590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRYSTAL T NGUYEN OD

Provider Business Mailing Address
First Line	:	6533 ROOSEVELT BLVD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149
Country	:	US
Telephone Number	:	215-744-6727
Fax Number	:	215-744-1622

Provider Business Practice Location Address
First Line	:	6533 ROOSEVELT BLVD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149
Country	:	US
Telephone Number	:	215-744-6727
Fax Number	:	215-744-1622

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	03/03/2011

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