Provider Demographics
NPI:1619719655
Name:NGUYEN, LUCAS HUY MAI
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:HUY MAI
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8010 SERENITY CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-2895
Mailing Address - Country:US
Mailing Address - Phone:832-563-8926
Mailing Address - Fax:
Practice Address - Street 1:9725 DATAPOINT DR STE 106
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2385
Practice Address - Country:US
Practice Address - Phone:210-585-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11146152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist