MEDICARE: SALLY TAM 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	9015T	TX

General Provider Information

NPI Number	:	1588016919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY TAM NGUYEN O.D.

Provider Business Mailing Address
First Line	:	9401 W UNIVERSITY DR STE 130
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-8983
Country	:	US
Telephone Number	:	469-899-2007
Fax Number	:	469-899-2007

Provider Business Practice Location Address
First Line	:	9401 W UNIVERSITY DR STE 130
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-8983
Country	:	US
Telephone Number	:	469-899-2007
Fax Number	:	469-899-2007

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

Provider Enumeration Date	:	07/11/2016
Last Update Date	:	04/02/2026

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