MEDICARE: DR. THOMAS M. 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	1206	AZ

General Provider Information

NPI Number	:	1750472312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS M. NGUYEN O.D.

Provider Business Mailing Address
First Line	:	7697 W TALTSON DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85743-7410
Country	:	US
Telephone Number	:	520-292-9668
Fax Number	:

Provider Business Practice Location Address
First Line	:	4701 N STONE AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-5700
Country	:	US
Telephone Number	:	520-292-1902
Fax Number	:

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/09/2007

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