Provider Demographics
NPI:1578041265
Name:NGUYEN, MARY THUY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:THUY
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6910 BELLAIRE BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-3545
Mailing Address - Country:US
Mailing Address - Phone:713-774-1124
Mailing Address - Fax:
Practice Address - Street 1:6910 BELLAIRE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-3545
Practice Address - Country:US
Practice Address - Phone:713-774-1124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9581T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty