Provider Demographics
NPI:1184741944
Name:NGUYEN, PHUONG (OD)
Entity type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:
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 1:1402 BERLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1010
Mailing Address - Country:US
Mailing Address - Phone:860-956-1396
Mailing Address - Fax:860-956-8175
Practice Address - Street 1:1402 BERLIN TPKE
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-1010
Practice Address - Country:US
Practice Address - Phone:860-956-1396
Practice Address - Fax:860-956-8175
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2615152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU97464Medicare UPIN