Individual
JIMMY NGUYEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D
Contact information
Practice address
2600 W 7TH ST STE 145, FORT WORTH, TX 76107-9301
(817) 806-0265
Mailing address
4417 CHESAPEAKE BAY DR, FORT WORTH, TX 76123-4029
(407) 408-5177
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC 4478
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OPC 4478
STATE LINCENSE
FL
Enumeration date
06/03/2010
Last updated
07/13/2021
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