Provider Demographics
NPI:1902137987
Name:NGUYEN, HUNG DUY (DO)
Entity Type:Individual
Prefix:DR
First Name:HUNG
Middle Name:DUY
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-6906
Mailing Address - Country:US
Mailing Address - Phone:254-776-4200
Mailing Address - Fax:254-741-1381
Practice Address - Street 1:4320 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-6906
Practice Address - Country:US
Practice Address - Phone:254-776-4200
Practice Address - Fax:254-741-1381
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7509T152W00000X
CAOPG13887152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist