Provider Demographics
NPI:1205088168
Name:NGUYEN, MAI HAN (OD)
Entity type:Individual
Prefix:
First Name:MAI HAN
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 1:120 DORMAN COMMERCE DR STE G
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-2649
Mailing Address - Country:US
Mailing Address - Phone:864-587-5886
Mailing Address - Fax:864-587-5632
Practice Address - Street 1:120 DORMAN COMMERCE DR STE G
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-2649
Practice Address - Country:US
Practice Address - Phone:864-587-5886
Practice Address - Fax:864-587-5632
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1527152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist