Provider Demographics
NPI:1679851737
Name:DR. MAI X. NGUYEN & ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:DR. MAI X. NGUYEN & ASSOCIATES, PLLC
Other - Org Name:SOUTHCENTER EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MAI
Authorized Official - Middle Name:X
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:425-557-5530
Mailing Address - Street 1:755 NW GILMAN BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5357
Mailing Address - Country:US
Mailing Address - Phone:425-557-5530
Mailing Address - Fax:425-427-8644
Practice Address - Street 1:755 NW GILMAN BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5357
Practice Address - Country:US
Practice Address - Phone:425-557-5530
Practice Address - Fax:425-427-8644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-23
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD 60167739152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty