Provider Demographics
NPI:1376774299
Name:NGUYEN, MINH VAN (OD)
Entity Type:Individual
Prefix:DR
First Name:MINH
Middle Name:VAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4524 WELLINGTON FARMS DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1209
Mailing Address - Country:US
Mailing Address - Phone:512-762-9523
Mailing Address - Fax:
Practice Address - Street 1:4524 WELLINGTON FARMS DR
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1209
Practice Address - Country:US
Practice Address - Phone:512-762-9523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7388T152W00000X
VA0618002552152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist