Individual provider Active NPI

DO Nguyen

  • Optometrist
  • Memphis, TN
National Provider Identifier
1407114663
Registry record updated Jul 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3049 Issued in TN
Practice address
428 Perkins Ext
Memphis, TN 38117
Phone
(901) 763-2020
Fax
(901) 763-2219
NPI assigned
Apr 25, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3049 TN Primary

Addresses

Primary practice location

428 Perkins Ext
Memphis, TN 38117

Mailing address

428 Perkins Ext
Memphis, TN 38117-3802
Phone (901) 763-2020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120709000578 TN Practitioner - Optometry 8325203748 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern College of OptometryGroup PAC ID 4587550454, 57 clinicians

Practice addresses (Care Compare)

1245 Madison Ave
Memphis, TN 38104-2211
Phone (901) 722-3385

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Eyecare Optical CurrentSince Jun 18, 2012 Accepting new patients
Wci School Health Services, PLLC CurrentSince Aug 1, 2013 Accepting new patients
Professional Eyecare Optical, PLLC Optometrist CurrentSince Jun 18, 2012 Accepting new patients
Southern College of Optometry Optometrist CurrentSince Sep 17, 2019 Accepting new patients

Locations

1350 Concourse Ave
Ste 264
Memphis, TN 38104
Phone (901) 252-3670

1245 Madison Ave
Memphis, TN 38104
Phone (901) 722-3250

1212 Vollintine Ave
Memphis, TN 38107
Phone (901) 531-6321

428 Perkins Ext
Memphis, TN 38117
Phone (901) 763-2020

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1335312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532476800000",
    "number": "1407114663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "428 PERKINS EXT",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381173802",
            "telephone_number": "901-763-2020",
            "fax_number": "901-763-2219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "428 PERKINS EXT",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "38117",
            "telephone_number": "901-763-2020",
            "fax_number": "901-763-2219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-25",
        "last_updated": "2018-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "3049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.