Provider Demographics
NPI:1013033075
Name:NGUYEN, HEATHER YVONNE (OD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:YVONNE
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 27TH STREET DR SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-1632
Mailing Address - Country:US
Mailing Address - Phone:785-550-1270
Mailing Address - Fax:
Practice Address - Street 1:2600 EDGEWOOD RD SW
Practice Address - Street 2:SUITE 376
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-7818
Practice Address - Country:US
Practice Address - Phone:319-390-4144
Practice Address - Fax:319-390-4674
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2502152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1013033075Medicaid
IA1013033075Medicaid
IAIB1603004Medicare UPIN