Provider Demographics
NPI:1356699276
Name:NGUYEN, MAI (OD)
Entity type:Individual
Prefix:DR
First Name:MAI
Middle Name:
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 1:6243 RETAIL RD
Mailing Address - Street 2:STE 800
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231
Mailing Address - Country:US
Mailing Address - Phone:214-890-9864
Mailing Address - Fax:214-360-7738
Practice Address - Street 1:6243 RETAIL RD
Practice Address - Street 2:STE 800
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231
Practice Address - Country:US
Practice Address - Phone:214-890-9864
Practice Address - Fax:214-360-7738
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7947T152W00000X
TX7947TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist