Provider Demographics
NPI:1336331610
Name:NGUYEN, MYAN THI (OD)
Entity Type:Individual
Prefix:DR
First Name:MYAN
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 1:151 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17554-1421
Mailing Address - Country:US
Mailing Address - Phone:360-908-8154
Mailing Address - Fax:
Practice Address - Street 1:151 CHURCH ST
Practice Address - Street 2:
Practice Address - City:MOUNTVILLE
Practice Address - State:PA
Practice Address - Zip Code:17554-1421
Practice Address - Country:US
Practice Address - Phone:360-908-8154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00004162152W00000X
PAOEG001996152W00000X
MDTA2171152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist