Provider Demographics
NPI:1467501247
Name:NGUYEN, LINDA THUY
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:THUY
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 BROOK WAY
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3212
Mailing Address - Country:US
Mailing Address - Phone:510-387-7724
Mailing Address - Fax:
Practice Address - Street 1:5101 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1624
Practice Address - Country:US
Practice Address - Phone:707-864-1888
Practice Address - Fax:707-864-1892
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12938T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist