Provider Demographics
NPI:1013170729
Name:DR. JULIE T. NGUYEN, PLLC
Entity Type:Organization
Organization Name:DR. JULIE T. NGUYEN, PLLC
Other - Org Name:DR. JULIE NGUYEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:THUYDUNG
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:979-480-9424
Mailing Address - Street 1:PO BOX 1314
Mailing Address - Street 2:
Mailing Address - City:ALIEF
Mailing Address - State:TX
Mailing Address - Zip Code:77411-1314
Mailing Address - Country:US
Mailing Address - Phone:281-818-5912
Mailing Address - Fax:
Practice Address - Street 1:121 HIGHWAY 332 W
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-4015
Practice Address - Country:US
Practice Address - Phone:979-480-9424
Practice Address - Fax:979-480-9426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7121TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K0538Medicare PIN