Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 8758T | TX |
NPI | 1003280017 |
---|---|
Provider Name | Dr. Tyler T Nguyen |
First Address | Fort Worth, TX 76131-4302 |
Second Address | Fort Worth, TX 76131-4302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2015 |
Last Update Date | 15/11/2015 |