Provider Demographics
NPI:1356375752
Name:NGUYEN, GARY NGOC (OD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-5134
Mailing Address - Country:US
Mailing Address - Phone:832-319-7732
Mailing Address - Fax:832-319-7737
Practice Address - Street 1:5601 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-5134
Practice Address - Country:US
Practice Address - Phone:832-319-7732
Practice Address - Fax:832-319-7737
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05813T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11616015OtherCAQH
TX1548182-03Medicaid
TX11616015OtherCAQH
TX1548182-03Medicaid