Provider Demographics
NPI:1033412770
Name:NGUYEN, MAI (OD)
Entity Type:Individual
Prefix:
First Name:MAI
Middle Name:
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 1:9814 FRY RD STE 180
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-5373
Mailing Address - Country:US
Mailing Address - Phone:832-653-6066
Mailing Address - Fax:
Practice Address - Street 1:9814 FRY RD STE 180
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-5373
Practice Address - Country:US
Practice Address - Phone:832-653-6066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-20
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT-2819152W00000X
TX7664TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist