Provider Demographics
NPI:1023145497
Name:NGUYEN, JACQUELINE HA (OD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:HA
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1816 BROADWAY ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-5664
Mailing Address - Country:US
Mailing Address - Phone:281-992-3937
Mailing Address - Fax:281-992-3899
Practice Address - Street 1:1816 BROADWAY ST
Practice Address - Street 2:SUITE 106
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5664
Practice Address - Country:US
Practice Address - Phone:281-992-3937
Practice Address - Fax:281-992-3899
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5483TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU66781Medicare UPIN
TX00512EMedicare ID - Type Unspecified