Individual
JENNIE NGUYEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
4600 GREENVILLE AVE, DALLAS, TX 75206-5062
(214) 363-5991
Mailing address
1836 STEWART DR, CARROLLTON, TX 75010-6329
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
046.010169
IL
152W00000X
Optometrist
Primary
8367
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001604768
BLUE CROSS & BLUE SHIELD
IL
05
—
046010169
—
IL
05
—
1427293638
—
TX
Enumeration date
12/03/2008
Last updated
01/05/2018
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