Provider Demographics
NPI:1831377217
Name:NGUYEN, PETER H (OD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:H
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 CURTNER AVE
Mailing Address - Street 2:SUITE 50
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-1061
Mailing Address - Country:US
Mailing Address - Phone:408-899-4126
Mailing Address - Fax:408-899-4142
Practice Address - Street 1:121 CURTNER AVE
Practice Address - Street 2:SUITE 50
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-1061
Practice Address - Country:US
Practice Address - Phone:408-899-4126
Practice Address - Fax:408-899-4142
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13067T152W00000X
NV571152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACZ691ZMedicare PIN