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NPI Code Detail

MEDICARE: DR. HOA PHUONG NGUYEN O.D.

MEDICARE: DR. HOA PHUONG 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
1152W00000XOptometristOPT 12630TCA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1BB516ZOTHERMEDICARE PTAN

General Provider Information

NPI Number : 1962439265
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HOA PHUONG NGUYEN O.D.
Provider Business Mailing Address
First Line : 7155 BROADWAY
Second Line :
City : LEMON GROVE
State : CA
Zip : 91945-1408
Country : US
Telephone Number : 619-315-0192
Fax Number :
Provider Business Practice Location Address
First Line : 7155 BROADWAY
Second Line :
City : LEMON GROVE
State : CA
Zip : 91945-1408
Country : US
Telephone Number : 619-315-0192
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2006
Last Update Date : 03/27/2024

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