Provider Demographics
NPI:1528378056
Name:VAN-ANH T. NGUYEN, O.D., P.C
Entity Type:Organization
Organization Name:VAN-ANH T. NGUYEN, O.D., P.C
Other - Org Name:VAN-ANH T. NGUYEN, O.D. & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:VAN-ANH
Authorized Official - Middle Name:T
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:703-490-5275
Mailing Address - Street 1:2700 POTOMAC MILLS CIR
Mailing Address - Street 2:SUITE 208-B
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4625
Mailing Address - Country:US
Mailing Address - Phone:703-490-5275
Mailing Address - Fax:703-490-1196
Practice Address - Street 1:2700 POTOMAC MILLS CIR
Practice Address - Street 2:SUITE 208-B
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4625
Practice Address - Country:US
Practice Address - Phone:703-490-5275
Practice Address - Fax:703-490-1196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000202152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA410001037Medicare PIN
VAU69832Medicare UPIN