Provider Demographics
NPI:1710338819
Name:NGUYEN, BACH (OD)
Entity Type:Individual
Prefix:DR
First Name:BACH
Middle Name:
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 1:6155 EASTEX FWY
Mailing Address - Street 2:STE 699
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-6701
Mailing Address - Country:US
Mailing Address - Phone:409-892-4790
Mailing Address - Fax:
Practice Address - Street 1:6155 EASTEX FWY
Practice Address - Street 2:STE 699
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-6718
Practice Address - Country:US
Practice Address - Phone:409-892-4790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8951TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist