Provider Demographics
NPI:1306026299
Name:NGUYEN, MINHTAM THI (OD)
Entity Type:Individual
Prefix:MISS
First Name:MINHTAM
Middle Name:THI
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 1:970 ALMADEN LAKE DR APT 204
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-5378
Mailing Address - Country:US
Mailing Address - Phone:408-292-2020
Mailing Address - Fax:
Practice Address - Street 1:730 STORY RD STE 8
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-2624
Practice Address - Country:US
Practice Address - Phone:408-292-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13404 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist