Provider Demographics
NPI:1144608472
Name:NGUYEN, XUAN NGUYEN NGOC (OD)
Entity Type:Individual
Prefix:
First Name:XUAN NGUYEN
Middle Name:NGOC
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 1:9710 SE WASHINGTON ST STE D
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-8407
Mailing Address - Country:US
Mailing Address - Phone:503-257-7770
Mailing Address - Fax:503-257-1322
Practice Address - Street 1:9710 SE WASHINGTON ST STE D
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216
Practice Address - Country:US
Practice Address - Phone:503-257-7770
Practice Address - Fax:503-257-1322
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3618AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist