Provider Demographics
NPI:1235427386
Name:NGUYEN, KIMUYEN (OD)
Entity Type:Individual
Prefix:
First Name:KIMUYEN
Middle Name:
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 1:4150 EST RENNER RD
Mailing Address - Street 2:STE 300
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082
Mailing Address - Country:US
Mailing Address - Phone:972-250-0700
Mailing Address - Fax:
Practice Address - Street 1:16731 COIT RD
Practice Address - Street 2:OPTICAL
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1750
Practice Address - Country:US
Practice Address - Phone:972-250-0700
Practice Address - Fax:972-930-0841
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7755TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist