1013033075 NPI number — HEATHER YVONNE NGUYEN O.D.

Table of content: HEATHER YVONNE NGUYEN O.D. (NPI 1013033075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013033075 NPI number — HEATHER YVONNE NGUYEN O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NGUYEN
Provider First Name:
HEATHER
Provider Middle Name:
YVONNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1013033075
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 27TH STREET DR SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR RAPIDS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52403-1632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-550-1270
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 EDGEWOOD RD SW
Provider Second Line Business Practice Location Address:
SUITE 376
Provider Business Practice Location Address City Name:
CEDAR RAPIDS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52404-7818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-390-4144
Provider Business Practice Location Address Fax Number:
319-390-4674
Provider Enumeration Date:
03/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2502 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1013033075 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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