Provider Demographics
NPI:1487768628
Name:NGUYEN, NGUYET-NGA T (OD)
Entity type:Individual
Prefix:DR
First Name:NGUYET-NGA
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 1:4308 PLANTERS CT
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3740
Mailing Address - Country:US
Mailing Address - Phone:703-425-5136
Mailing Address - Fax:
Practice Address - Street 1:900 S. WASHINGTON ST.
Practice Address - Street 2:#102
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046
Practice Address - Country:US
Practice Address - Phone:703-534-1888
Practice Address - Fax:703-534-1889
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000275152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9230262Medicaid
554996Medicare ID - Type Unspecified
U18273Medicare UPIN