Provider Demographics
NPI:1710263819
Name:NGUYEN, PHOEBE HA-THANH (OD)
Entity Type:Individual
Prefix:
First Name:PHOEBE
Middle Name:HA-THANH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 S 20TH ST
Mailing Address - Street 2:APT C
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-2265
Mailing Address - Country:US
Mailing Address - Phone:408-416-1075
Mailing Address - Fax:
Practice Address - Street 1:228 DEL MONTE SHPG CTR
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940
Practice Address - Country:US
Practice Address - Phone:831-375-7755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 14319 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist