Provider Demographics
NPI:1235876582
Name:NGUYEN, JENNY MY LINH (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:MY LINH
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 1:716 WILLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-5113
Mailing Address - Country:US
Mailing Address - Phone:817-917-8430
Mailing Address - Fax:
Practice Address - Street 1:1650 HIGHWAY 287 N
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8852
Practice Address - Country:US
Practice Address - Phone:682-518-1177
Practice Address - Fax:682-518-8889
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10274152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty