Provider Demographics
NPI:1447317581
Name:NGUYEN, VAN-ANH T (OD)
Entity type:Individual
Prefix:
First Name:VAN-ANH
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 POTOMAC MILLS CIR STE 324B
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4654
Mailing Address - Country:US
Mailing Address - Phone:703-490-5275
Mailing Address - Fax:703-490-1196
Practice Address - Street 1:2700 POTOMAC MILLS CIR STE 324B
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4654
Practice Address - Country:US
Practice Address - Phone:703-490-5275
Practice Address - Fax:703-490-1196
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000202152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist