Provider Demographics
NPI:1497248397
Name:NGUYEN, MY LAN THI (OD, MS)
Entity Type:Individual
Prefix:
First Name:MY LAN
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD, MS
Other - Prefix:
Other - First Name:MYLAN
Other - Middle Name:THI
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD, MS
Mailing Address - Street 1:10404 WINGTIP DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77075-3000
Mailing Address - Country:US
Mailing Address - Phone:713-499-9708
Mailing Address - Fax:
Practice Address - Street 1:5115 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-9749
Practice Address - Country:US
Practice Address - Phone:713-580-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9445T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist