Provider Demographics
NPI:1750490413
Name:NGUYEN, THY THY (OD)
Entity Type:Individual
Prefix:
First Name:THY
Middle Name:THY
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 1:100 E CALIFORNIA BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3205
Mailing Address - Country:US
Mailing Address - Phone:626-269-5371
Mailing Address - Fax:265-772-1006
Practice Address - Street 1:12828 HARBOR BLVD STE 305
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-5835
Practice Address - Country:US
Practice Address - Phone:714-534-8100
Practice Address - Fax:714-534-1345
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12746T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist