MEDICARE: DUNG DUY NGUYEN OD

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	8566T	TX

General Provider Information

NPI Number	:	1922499805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUNG DUY NGUYEN OD

Provider Business Mailing Address
First Line	:	4420 N TARRANT PKWY STE 146
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-4922
Country	:	US
Telephone Number	:	469-481-6688
Fax Number	:	855-623-3937

Provider Business Practice Location Address
First Line	:	4420 N TARRANT PKWY STE 146
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-4922
Country	:	US
Telephone Number	:	817-788-2020
Fax Number	:

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

Provider Enumeration Date	:	02/12/2015
Last Update Date	:	09/21/2023

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