MEDICARE: DR. DIANA 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	TUV0072861	NY

General Provider Information

NPI Number	:	1831352137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANA NGUYEN O.D.

Provider Business Mailing Address
First Line	:	2057 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-3203
Country	:	US
Telephone Number	:	718-355-9656
Fax Number	:	718-355-9654

Provider Business Practice Location Address
First Line	:	2057 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-3203
Country	:	US
Telephone Number	:	718-355-9656
Fax Number	:	718-355-9654

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

Provider Enumeration Date	:	07/07/2008
Last Update Date	:	02/04/2015

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