MEDICARE: LONG DUY NGUYEN OD PA

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	06456TG	TX

General Provider Information

NPI Number	:	1659606044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONG DUY NGUYEN OD PA

Provider Business Mailing Address
First Line	:	10953 WESTHEIMER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-3203
Country	:	US
Telephone Number	:	713-774-3093
Fax Number	:

Provider Business Practice Location Address
First Line	:	10953 WESTHEIMER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-3203
Country	:	US
Telephone Number	:	713-774-3093
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST/PRESIDENT
Name	:	DR. LONG DUY NGUYEN
Credential	:	O.D.
Telephone Number	:	713-774-3093

Provider Enumeration Date	:	10/02/2009
Last Update Date	:	10/02/2009

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