Provider Demographics
NPI:1154841278
Name:NGUYEN, THU (OD)
Entity Type:Individual
Prefix:DR
First Name:THU
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:THU
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:6946 SILVER SAGE CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-1151
Mailing Address - Country:US
Mailing Address - Phone:813-317-0371
Mailing Address - Fax:
Practice Address - Street 1:10500 ULMERTON RD STE 278
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3537
Practice Address - Country:US
Practice Address - Phone:813-317-0371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5420152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist