Provider Demographics
NPI:1700505351
Name:ANN HUYNH NGUYEN OD LLC
Entity Type:Organization
Organization Name:ANN HUYNH NGUYEN OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUYNH NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:904-280-4855
Mailing Address - Street 1:1334 N KYLE WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-1927
Mailing Address - Country:US
Mailing Address - Phone:904-280-4855
Mailing Address - Fax:904-280-4853
Practice Address - Street 1:6100 GREENLAND RD STE 604
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-2453
Practice Address - Country:US
Practice Address - Phone:904-280-4855
Practice Address - Fax:904-280-4853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty