Provider Demographics
NPI:1164506390
Name:NGUYEN, JANINE TRAN (OD)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:TRAN
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:PO BOX 1186
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-1186
Mailing Address - Country:US
Mailing Address - Phone:229-382-4765
Mailing Address - Fax:229-382-4819
Practice Address - Street 1:2012 PINEVIEW AVE
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3035
Practice Address - Country:US
Practice Address - Phone:229-382-4765
Practice Address - Fax:229-382-4819
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6699T152W00000X
VA0618001816152W00000X
GAOPT002801152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA169301Medicare PIN
TX8F8156Medicare PIN