Provider Demographics
NPI:1770966525
Name:NGUYEN, LISA P (OD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:P
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 1:1400 NE 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-2429
Mailing Address - Country:US
Mailing Address - Phone:408-518-2628
Mailing Address - Fax:
Practice Address - Street 1:5 DAKOTA DR STE 307
Practice Address - Street 2:
Practice Address - City:NORTH NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1106
Practice Address - Country:US
Practice Address - Phone:408-518-2628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33818TLG152W00000X
OR3622AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist