Provider Demographics
NPI:1982911566
Name:NGUYEN, TINA (OD)
Entity Type:Individual
Prefix:DR
First Name:TINA
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 1:2910 GULF FWY S
Mailing Address - Street 2:SUITE F-2
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-6790
Mailing Address - Country:US
Mailing Address - Phone:281-337-1081
Mailing Address - Fax:281-330-1361
Practice Address - Street 1:2910 GULF FWY S
Practice Address - Street 2:SUITE F-2
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-6790
Practice Address - Country:US
Practice Address - Phone:281-337-1081
Practice Address - Fax:281-330-1361
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7414TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist