MEDICARE: KENNETH NGUYEN

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	832	NV

General Provider Information

NPI Number	:	1861862211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH NGUYEN

Provider Business Mailing Address
First Line	:	7260 W AZURE DR
Second Line	:	SUITE 140-524
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-7999
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6150 SMOKE RANCH RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-3814
Country	:	US
Telephone Number	:	702-727-3525
Fax Number	:

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

Provider Enumeration Date	:	09/28/2015
Last Update Date	:	09/28/2015

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Directions to “ KENNETH NGUYEN ” Practice Location

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