MEDICARE: HOA THI 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	6917TG	TX
2	152WC0802X	Corneal and Contact Management Optometrist	6917TG	TX

General Provider Information

NPI Number	:	1942314943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOA THI NGUYEN

Provider Business Mailing Address
First Line	:	1509 DUTCHMAN CREEK DR
Second Line	:
City	:	DESOTO
State	:	TX
Zip	:	75115-3661
Country	:	US
Telephone Number	:	713-502-8428
Fax Number	:

Provider Business Practice Location Address
First Line	:	6121 W PARK BLVD
Second Line	:	SUITE C216
City	:	PLANO
State	:	TX
Zip	:	75093-6221
Country	:	US
Telephone Number	:	972-400-5522
Fax Number	:

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	06/23/2011

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Directions to “ HOA THI NGUYEN ” Practice Location

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