Provider Demographics
NPI:1700842739
Name:NGUYEN, QUYEN CAO (OD)
Entity Type:Individual
Prefix:DR
First Name:QUYEN
Middle Name:CAO
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:PO BOX 6256
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79906-0256
Mailing Address - Country:US
Mailing Address - Phone:714-235-4200
Mailing Address - Fax:
Practice Address - Street 1:8401 GATEWAY BLVD W
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-5668
Practice Address - Country:US
Practice Address - Phone:915-775-4916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12765 T152W00000X
TX6670 T152W00000X
VA0618001554152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0127650Medicaid
CASD0127650OtherBLUE SHIELD OF CALIFORNIA
TX0060RNOtherBLUECROSS BLUESHIELD OF TEXAS
TX613879OtherTRAILBLAZER - MEDICARE