Provider Demographics
NPI:1407114663
Name:NGUYEN, DO
Entity Type:Individual
Prefix:
First Name:DO
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 PERKINS EXT
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-3802
Mailing Address - Country:US
Mailing Address - Phone:901-763-2020
Mailing Address - Fax:901-763-2219
Practice Address - Street 1:428 PERKINS EXT
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117
Practice Address - Country:US
Practice Address - Phone:901-763-2020
Practice Address - Fax:901-763-2219
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3049152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist