Provider Demographics
NPI:1861185613
Name:NGUYEN, PHUONG-NGHI (OD)
Entity type:Individual
Prefix:
First Name:PHUONG-NGHI
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 1:7145 HARMONY GLEN DR
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-3197
Mailing Address - Country:US
Mailing Address - Phone:714-794-4105
Mailing Address - Fax:
Practice Address - Street 1:7145 HARMONY GLEN DR
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-3197
Practice Address - Country:US
Practice Address - Phone:714-794-4105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.007168152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist