Provider Demographics
NPI:1184789877
Name:NGUYEN, MANNY T (OD)
Entity type:Individual
Prefix:DR
First Name:MANNY
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:59 WASHINGTON STREET
Mailing Address - Street 2:STE 328
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050
Mailing Address - Country:US
Mailing Address - Phone:408-439-1916
Mailing Address - Fax:650-625-1689
Practice Address - Street 1:1709 AUTOMATION PKWY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-1866
Practice Address - Country:US
Practice Address - Phone:408-435-7885
Practice Address - Fax:408-435-7887
Is Sole Proprietor?:No
Enumeration Date:2006-12-24
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11277152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist