Provider Demographics
NPI:1013064609
Name:NGUYEN, MARY C (OD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:C
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:PO BOX 150293
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-6293
Mailing Address - Country:US
Mailing Address - Phone:817-557-6472
Mailing Address - Fax:817-557-2315
Practice Address - Street 1:1600 W ARBROOK BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-4107
Practice Address - Country:US
Practice Address - Phone:817-557-6472
Practice Address - Fax:817-557-2315
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4693T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist