Provider Demographics
NPI:1326034711
Name:NGUYEN-DUONG, HUONG T (OD)
Entity Type:Individual
Prefix:
First Name:HUONG
Middle Name:T
Last Name:NGUYEN-DUONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:
Other - Last Name:DUONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:5203A LYNGATE CT
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1632
Mailing Address - Country:US
Mailing Address - Phone:703-764-2015
Mailing Address - Fax:703-503-4482
Practice Address - Street 1:5203A LYNGATE CT
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1632
Practice Address - Country:US
Practice Address - Phone:703-764-2015
Practice Address - Fax:703-503-4482
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000588152W00000X
MDTA1393152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010048516Medicaid
DC036211200Medicaid
MD406593000Medicaid
G01581Medicare ID - Type Unspecified
VA010048516Medicaid