Provider Demographics
NPI:1730267253
Name:NGUYEN, PHUONG-ANH THI (OD)
Entity type:Individual
Prefix:DR
First Name:PHUONG-ANH
Middle Name:THI
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 1:10420 BROADWAY ST STE C
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7852
Mailing Address - Country:US
Mailing Address - Phone:281-992-5888
Mailing Address - Fax:713-436-5154
Practice Address - Street 1:10420 BROADWAY ST STE C
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7852
Practice Address - Country:US
Practice Address - Phone:281-992-5888
Practice Address - Fax:713-436-5154
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5587 TG152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP081034E4Medicaid
TX81034EMedicare ID - Type Unspecified
TXP081034E4Medicaid