Provider Demographics
NPI:1629621388
Name:NGUYEN, NAM (ABOC)
Entity Type:Individual
Prefix:
First Name:NAM
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 PERKINS RD STE 330
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-2292
Mailing Address - Country:US
Mailing Address - Phone:225-388-0028
Mailing Address - Fax:225-388-0028
Practice Address - Street 1:3535 PERKINS RD STE 330
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-2292
Practice Address - Country:US
Practice Address - Phone:225-388-0028
Practice Address - Fax:225-388-0032
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207139156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA207139OtherAMERICAN BOARD OF OPTICIAN CERTIFICATION