Provider Demographics
NPI:1710539283
Name:NGUYEN, JENNIFER THI (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:955 W SOUTHERN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-4903
Mailing Address - Country:US
Mailing Address - Phone:480-961-1865
Mailing Address - Fax:480-893-8172
Practice Address - Street 1:1672 E GUADALUPE RD STE 111
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-8167
Practice Address - Country:US
Practice Address - Phone:480-892-6495
Practice Address - Fax:480-892-8167
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD-920152W00000X
AZOPT-002739152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist