Provider Demographics
NPI:1619131869
Name:NGUYEN, REGINA THUY VY (OD)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:THUY VY
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14870 SPACE CENTER BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-2368
Mailing Address - Country:US
Mailing Address - Phone:281-984-7515
Mailing Address - Fax:302-394-1563
Practice Address - Street 1:14870 SPACE CENTER BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-2368
Practice Address - Country:US
Practice Address - Phone:281-984-7515
Practice Address - Fax:302-394-1563
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7262TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX317064901Medicaid
TX268847YNQBMedicare PIN