MEDICARE: DR. GWENDOLYN QUYNH ANH 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	0618003545	VA

General Provider Information

NPI Number	:	1629960927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GWENDOLYN QUYNH ANH NGUYEN OD

Provider Business Mailing Address
First Line	:	2924 PRINCE WILLIAM PKWY
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-4145
Country	:	US
Telephone Number	:	703-763-1390
Fax Number	:	703-763-1395

Provider Business Practice Location Address
First Line	:	2924 PRINCE WILLIAM PKWY
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-4145
Country	:	US
Telephone Number	:	703-763-1390
Fax Number	:	703-763-1395

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

Provider Enumeration Date	:	07/19/2025
Last Update Date	:	12/15/2025

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