Provider Demographics
NPI:1255680781
Name:NGUYEN, JENNIFER PHUONG-UYEN (OD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:PHUONG-UYEN
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 1:955 W SOUTHERN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-4903
Mailing Address - Country:US
Mailing Address - Phone:809-611-8654
Mailing Address - Fax:
Practice Address - Street 1:2840 HIGHWAY 95 STE 416-418
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7792
Practice Address - Country:US
Practice Address - Phone:928-704-1808
Practice Address - Fax:928-704-1814
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60242980152W00000X
AZOPT-002767152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist