Provider Demographics
NPI:1568818953
Name:DUONG, NGHIEM (OD)
Entity Type:Individual
Prefix:
First Name:NGHIEM
Middle Name:
Last Name:DUONG
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 1:4150 E RENNER RD # 300
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-2816
Mailing Address - Country:US
Mailing Address - Phone:972-250-0700
Mailing Address - Fax:303-800-2078
Practice Address - Street 1:4150 E RENNER RD # 300
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-2816
Practice Address - Country:US
Practice Address - Phone:972-250-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9037TG152W00000X
OK2883152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX370923001Medicaid