Provider Demographics
NPI:1629409149
Name:JESSICA U NGUYEN OD PC
Entity Type:Organization
Organization Name:JESSICA U NGUYEN OD PC
Other - Org Name:TOWN EAST VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:UYEN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-613-3581
Mailing Address - Street 1:2124 TOWN EAST MALL
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4119
Mailing Address - Country:US
Mailing Address - Phone:972-613-3581
Mailing Address - Fax:972-279-1829
Practice Address - Street 1:2124 TOWN EAST MALL
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4119
Practice Address - Country:US
Practice Address - Phone:972-613-3581
Practice Address - Fax:972-279-1829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6948TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty