Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1108 | NV |
N | 152W00000X | Optometrist | 9807 | TX |
N | 152W00000X | Optometrist | R-283-TA-B89 | AL |
NPI | 1013479054 |
---|---|
Provider Name | Nancy Tran Phan Gauthier |
First Address | Henderson, NV 89052-0404 |
Second Address | Henderson, NV 89052-0404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2019 |
Last Update Date | 02/11/2021 |