MEDICARE: DR. BAO-TRAN DINH 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	6235	TX

General Provider Information

NPI Number	:	1629114798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BAO-TRAN DINH NGUYEN O.D.

Provider Business Mailing Address
First Line	:	12714 BRIAR HARBOR DR
Second Line	:
City	:	TOMBALL
State	:	TX
Zip	:	77377-8076
Country	:	US
Telephone Number	:	713-294-8123
Fax Number	:

Provider Business Practice Location Address
First Line	:	455 GREENSPOINT MALL
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-1815
Country	:	US
Telephone Number	:	713-294-8123
Fax Number	:

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	08/30/2007

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