Provider Demographics
NPI:1205677648
Name:NGUYEN, NIKI N (OD)
Entity type:Individual
Prefix:
First Name:NIKI
Middle Name:N
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 1:9091 FAIR OAKS PKWY STE 306
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS RANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78015-4690
Mailing Address - Country:US
Mailing Address - Phone:210-698-6393
Mailing Address - Fax:210-698-9788
Practice Address - Street 1:9091 FAIR OAKS PKWY STE 306
Practice Address - Street 2:
Practice Address - City:FAIR OAKS RANCH
Practice Address - State:TX
Practice Address - Zip Code:78015-4690
Practice Address - Country:US
Practice Address - Phone:210-698-6393
Practice Address - Fax:210-698-9788
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11186152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist