MEDICARE: MAI NGUYEN OD PLLC

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

General Provider Information

NPI Number	:	1902244924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAI NGUYEN OD PLLC

Provider Business Mailing Address
First Line	:	2401 S STEMMONS FWY
Second Line	:	SUITE 2210
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-8775
Country	:	US
Telephone Number	:	972-459-4908
Fax Number	:	972-316-0169

Provider Business Practice Location Address
First Line	:	2401 S STEMMONS FWY
Second Line	:	SUITE 2210
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-8775
Country	:	US
Telephone Number	:	972-459-4908
Fax Number	:	972-316-0169

Authorized Official
Title or Position	:	OWNER
Name	:	MAI ANH NGUYEN
Credential	:	OD
Telephone Number	:	972-459-4908

Provider Enumeration Date	:	06/12/2013
Last Update Date	:	09/05/2013

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