Provider Demographics
NPI:1669554812
Name:NGUYEN, DIEM T (OD)
Entity type:Individual
Prefix:
First Name:DIEM
Middle Name:T
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 1:601 HALTON RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3403
Mailing Address - Country:US
Mailing Address - Phone:864-458-7956
Mailing Address - Fax:864-458-8390
Practice Address - Street 1:220 S PENDLETON ST
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-3048
Practice Address - Country:US
Practice Address - Phone:864-859-3233
Practice Address - Fax:864-850-4001
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618-001238152W00000X
SC2301152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD23017Medicaid
SC2301OtherSC LICENSE
VA010216974Medicaid
VA010217024Medicaid
VA010217083Medicaid
VA186314OtherANTHEM BCBS/HEALTHKEEPERS
VA186437OtherANTHEM BCBS/HEALTHKEEPERS
VA186432OtherANTHEM BCBS/HEALTHKEEPERS
VA10217059Medicaid
SC2301OtherSC LICENSE
VA186331OtherANTHEM BCBS/HEALTHKEEPERS