Provider Demographics
NPI:1851717243
Name:THAI-AN NGUYEN OD PLLC
Entity Type:Organization
Organization Name:THAI-AN NGUYEN OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THAI-AN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-641-0011
Mailing Address - Street 1:2634 S CARRIER PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-5005
Mailing Address - Country:US
Mailing Address - Phone:972-641-0011
Mailing Address - Fax:972-641-8206
Practice Address - Street 1:2634 S CARRIER PKWY STE 101
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-5005
Practice Address - Country:US
Practice Address - Phone:972-641-0011
Practice Address - Fax:972-641-8206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7739TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX341422Medicare PIN