Provider Demographics
NPI:1578524088
Name:DOYLE, NGHI NINA NGUYEN PHUONG (OD)
Entity Type:Individual
Prefix:DR
First Name:NGHI NINA
Middle Name:NGUYEN PHUONG
Last Name:DOYLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1702 TRANSPORTATION BLVD
Mailing Address - Street 2:SUITE I
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2149
Mailing Address - Country:US
Mailing Address - Phone:410-721-2500
Mailing Address - Fax:410-721-1308
Practice Address - Street 1:1702 TRANSPORTATION BLVD
Practice Address - Street 2:SUITE I
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2149
Practice Address - Country:US
Practice Address - Phone:410-721-2500
Practice Address - Fax:410-721-1308
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1908152W00000X
PAOEG00148152W00000X
CA12306T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406792400Medicaid
MDV03695Medicare UPIN