Provider Demographics
NPI:1619242351
Name:NGUYEN, MAGGIE B (OD)
Entity Type:Individual
Prefix:DR
First Name:MAGGIE
Middle Name:B
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 1:12350 CARMEL MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4616
Mailing Address - Country:US
Mailing Address - Phone:858-673-1221
Mailing Address - Fax:
Practice Address - Street 1:12350 CARMEL MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-4616
Practice Address - Country:US
Practice Address - Phone:858-673-1221
Practice Address - Fax:858-201-3345
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11718152W00000X
CA11718T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist