Provider Demographics
NPI:1417079575
Name:NGUYEN, DUC QUI (OD)
Entity Type:Individual
Prefix:DR
First Name:DUC
Middle Name:QUI
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 1:6849 OLD DOMINION DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3724
Mailing Address - Country:US
Mailing Address - Phone:703-442-0522
Mailing Address - Fax:703-442-0525
Practice Address - Street 1:6849 OLD DOMINION DR
Practice Address - Street 2:SUITE 300
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3724
Practice Address - Country:US
Practice Address - Phone:703-442-0522
Practice Address - Fax:703-442-0525
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618-000735152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA116445OtherBC BS PIN
VA116445OtherBC BS PIN
VAU73417Medicare UPIN
VAG01590Medicare ID - Type UnspecifiedGROUP ID