Provider Demographics
NPI:1770755316
Name:DRS. NGUYEN PROF. CORP.
Entity type:Organization
Organization Name:DRS. NGUYEN PROF. CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:PHUOC
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:702-258-5573
Mailing Address - Street 1:6520 ATLANTA HWY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-4245
Mailing Address - Country:US
Mailing Address - Phone:334-277-7751
Mailing Address - Fax:
Practice Address - Street 1:6520 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-4245
Practice Address - Country:US
Practice Address - Phone:334-277-7751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-902-TA-452152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty