Provider Demographics
NPI:1629373857
Name:NGUYEN, JASON NGOC LAM (OD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:NGOC LAM
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 S FRY RD
Mailing Address - Street 2:STE 100-B
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-3376
Mailing Address - Country:US
Mailing Address - Phone:281-991-3937
Mailing Address - Fax:281-991-6836
Practice Address - Street 1:6501 S FRY RD
Practice Address - Street 2:STE 100B
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-3376
Practice Address - Country:US
Practice Address - Phone:281-392-5033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-19
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7413TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7413TGOtherOPTOMETRY LICENSE