1679851737 NPI number — DR. MAI X. NGUYEN & ASSOCIATES, PLLC

Table of content: (NPI 1679851737)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679851737 NPI number — DR. MAI X. NGUYEN & ASSOCIATES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. MAI X. NGUYEN & ASSOCIATES, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOUTHCENTER EYE CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679851737
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
755 NW GILMAN BLVD
Provider Second Line Business Mailing Address:
SUITE G
Provider Business Mailing Address City Name:
ISSAQUAH
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98027-5357
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-557-5530
Provider Business Mailing Address Fax Number:
425-427-8644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
755 NW GILMAN BLVD
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
ISSAQUAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98027-5357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-557-5530
Provider Business Practice Location Address Fax Number:
425-427-8644
Provider Enumeration Date:
07/23/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
MAI
Authorized Official Middle Name:
X.
Authorized Official Title or Position:
OPTOMETRIC PHYSICIAN
Authorized Official Telephone Number:
425-557-5530

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OD 60167739 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)