Provider Demographics
NPI:1083640320
Name:THAM NGUYEN, O.D., P.A.
Entity Type:Organization
Organization Name:THAM NGUYEN, O.D., P.A.
Other - Org Name:BANDERA FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-256-2020
Mailing Address - Street 1:PO BOX 1271
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-1271
Mailing Address - Country:US
Mailing Address - Phone:210-256-2020
Mailing Address - Fax:210-256-2025
Practice Address - Street 1:11311 BANDERA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-6812
Practice Address - Country:US
Practice Address - Phone:210-256-2020
Practice Address - Fax:210-256-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6832T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV09469Medicare UPIN