Basic Information
| Provider Information | |||||||||
| NPI: | 1093253247 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | MINH-TAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8424 OLD KEENE MILL RD | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221522302 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 8424 OLD KEENE MILL RD | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221522302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035696611 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2017 | ||||||||
| LastUpdateDate: | 09/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OEG003247 | PA | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 0618002638 | VA | Y | Eye and Vision Services Providers | Optometrist | 152W00000X | TA2628 | MD | N | Eye and Vision Services Providers | Optometrist |
No ID Information.