Provider Demographics
NPI:1609895093
Name:NGUYEN, DIEM THUY HONG (OD)
Entity Type:Individual
Prefix:
First Name:DIEM THUY
Middle Name:HONG
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 1:33 MAIN ST STE 180
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-2983
Mailing Address - Country:US
Mailing Address - Phone:817-605-6060
Mailing Address - Fax:817-656-5050
Practice Address - Street 1:33 MAIN ST STE 180
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-2983
Practice Address - Country:US
Practice Address - Phone:817-605-6060
Practice Address - Fax:817-656-5050
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05785TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV06000Medicare UPIN
TX611904Medicare PIN