Provider Demographics
NPI:1548576671
Name:NGUYEN, THU TRANG THI (OD)
Entity Type:Individual
Prefix:
First Name:THU TRANG
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 NE 165TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-8681
Mailing Address - Country:US
Mailing Address - Phone:360-433-9872
Mailing Address - Fax:
Practice Address - Street 1:970 NW EASTMAN PKWY
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5533
Practice Address - Country:US
Practice Address - Phone:503-666-7703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60167666152W00000X
OR3364AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist