Provider Demographics
NPI:1346760204
Name:NGUYEN, VI THAO (OD)
Entity Type:Individual
Prefix:DR
First Name:VI
Middle Name:THAO
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 1:7595 BLUE QUAIL LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5808
Mailing Address - Country:US
Mailing Address - Phone:407-731-9638
Mailing Address - Fax:
Practice Address - Street 1:1040 CYPRESS PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3328
Practice Address - Country:US
Practice Address - Phone:407-654-5453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5415152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOPC5415OtherFLORIDA OPTOMETRY LICENSE