Provider Demographics
NPI:1598730137
Name:NGUYEN, TU QUYNH THI (OD)
Entity Type:Individual
Prefix:DR
First Name:TU QUYNH
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 1:121 CENTRE ST
Mailing Address - Street 2:UNIT 203
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2878
Mailing Address - Country:US
Mailing Address - Phone:617-232-5118
Mailing Address - Fax:
Practice Address - Street 1:1558 DORCHESTER AVE
Practice Address - Street 2:UNIT 1R
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-1354
Practice Address - Country:US
Practice Address - Phone:617-288-0888
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA4294152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0700525Medicaid
MAW17514Medicare ID - Type Unspecified
MAU92125Medicare UPIN