MEDICARE: DR. LISA P. 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	33818TLG	CA
2	152W00000X	Optometrist	3622AT	OR

General Provider Information

NPI Number	:	1770966525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA P. NGUYEN O.D.

Provider Business Mailing Address
First Line	:	1400 NE 92ND AVE
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98664-2429
Country	:	US
Telephone Number	:	408-518-2628
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 DAKOTA DR STE 307
Second Line	:
City	:	NORTH NEW HYDE PARK
State	:	NY
Zip	:	11042-1106
Country	:	US
Telephone Number	:	877-506-0002
Fax Number	:

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

Provider Enumeration Date	:	06/29/2015
Last Update Date	:	01/20/2026

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