Provider Demographics
NPI:1588016919
Name:NGUYEN, SALLY TAM (OD)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:TAM
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:TAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:8710 W UNIVERSITY DR STE 120
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-7826
Mailing Address - Country:US
Mailing Address - Phone:469-899-2007
Mailing Address - Fax:
Practice Address - Street 1:8710 W UNIVERSITY DR STE 120
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-7826
Practice Address - Country:US
Practice Address - Phone:469-899-2007
Practice Address - Fax:469-899-2007
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9015T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist