Provider Demographics
NPI:1255873725
Name:NGUYEN, DUY (RSLD)
Entity type:Individual
Prefix:
First Name:DUY
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:RSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15700 MONTEREY RD SUITE 100
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-7135
Mailing Address - Country:US
Mailing Address - Phone:669-888-3883
Mailing Address - Fax:
Practice Address - Street 1:15700 MONTEREY RD STE 100
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037
Practice Address - Country:US
Practice Address - Phone:669-888-3883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASL40644156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician