Provider Demographics
NPI:1053497172
Name:NGUYEN, TAMMY (OD)
Entity Type:Individual
Prefix:
First Name:TAMMY
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 1:3045 BALMORAL DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-1704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1818 TULLY RD
Practice Address - Street 2:158B
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1883
Practice Address - Country:US
Practice Address - Phone:408-274-0998
Practice Address - Fax:408-274-2060
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11933T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14008OtherMEDICAL EYE SERVICE