Provider Demographics
NPI:1629114798
Name:NGUYEN, BAO-TRAN DINH (OD)
Entity Type:Individual
Prefix:DR
First Name:BAO-TRAN
Middle Name:DINH
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 1:12714 BRIAR HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-8076
Mailing Address - Country:US
Mailing Address - Phone:713-294-8123
Mailing Address - Fax:
Practice Address - Street 1:455 GREENSPOINT MALL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-1815
Practice Address - Country:US
Practice Address - Phone:713-294-8123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6235152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist