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Individual

RYAN NGUYEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
INDIAN RTE 7 & INDIAN ROUTE 12, FORT DEFIANCE, AZ 86504
(928) 729-8000
Mailing address
3851 E BALSAM DR, CHANDLER, AZ 85286-0210
(480) 685-7811

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT-002263
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
OPT-002263
ARIZONA OPTOMETRY LICENSE
AZ
Enumeration date
07/10/2018
Last updated
07/10/2018
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