Provider Demographics
NPI:1093197907
Name:NGUYEN, THANH XUAN (OD)
Entity Type:Individual
Prefix:DR
First Name:THANH
Middle Name:XUAN
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 1:8633 STATUE WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-9541
Mailing Address - Country:US
Mailing Address - Phone:916-627-0332
Mailing Address - Fax:
Practice Address - Street 1:1151 GALLERIA BLVD STE 175
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-1942
Practice Address - Country:US
Practice Address - Phone:916-788-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-27
Last Update Date:2015-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15318152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist