Provider Demographics
NPI:1417269978
Name:NGUYEN, MAI XUAN (OD)
Entity Type:Individual
Prefix:
First Name:MAI
Middle Name:XUAN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MAIXUAN
Other - Middle Name:THI
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:755 NW GILMAN BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5370
Mailing Address - Country:US
Mailing Address - Phone:425-557-5530
Mailing Address - Fax:425-645-0007
Practice Address - Street 1:755 NW GILMAN BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027
Practice Address - Country:US
Practice Address - Phone:425-557-5530
Practice Address - Fax:425-427-8644
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60167739152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1417269978OtherNPI