Provider Demographics
NPI:1083809891
Name:NGUYEN, THUC KHAI (OD)
Entity Type:Individual
Prefix:DR
First Name:THUC
Middle Name:KHAI
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 INDIAN RUN ST
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-3706
Mailing Address - Country:US
Mailing Address - Phone:484-875-9591
Mailing Address - Fax:484-875-9725
Practice Address - Street 1:270 INDIAN RUN ST
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-3706
Practice Address - Country:US
Practice Address - Phone:484-875-9591
Practice Address - Fax:484-875-9725
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001936152W00000X
DEI3-0001324152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE003891S05Medicare PIN