Provider Demographics
NPI:1497808976
Name:TA, JULIA NGUYEN (OD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:NGUYEN
Last Name:TA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:XUAN-LAN
Other - Middle Name:THI
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2934 PEGASUS CT
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8042
Mailing Address - Country:US
Mailing Address - Phone:510-300-5810
Mailing Address - Fax:
Practice Address - Street 1:2325 W INTERSTATE 20
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3927
Practice Address - Country:US
Practice Address - Phone:925-945-8300
Practice Address - Fax:925-945-8757
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13104152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist