Provider Demographics
NPI:1760531107
Name:MA, PHUOC NGUYEN (OD)
Entity Type:Individual
Prefix:
First Name:PHUOC
Middle Name:NGUYEN
Last Name:MA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:MA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:3458 W FRANKFURT DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-1471
Mailing Address - Country:US
Mailing Address - Phone:480-363-9858
Mailing Address - Fax:
Practice Address - Street 1:1710 S GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3481
Practice Address - Country:US
Practice Address - Phone:480-892-6954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1485152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist