Provider Demographics
NPI:1053415687
Name:NGUYEN, LOREN
Entity type:Individual
Prefix:
First Name:LOREN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12525 INTERSTATE 10 E
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-1347
Mailing Address - Country:US
Mailing Address - Phone:409-724-7700
Mailing Address - Fax:
Practice Address - Street 1:3624 HIGHWAY 365
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-7835
Practice Address - Country:US
Practice Address - Phone:409-724-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4850T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX038186502Medicaid
TX0077FAOtherBLUE CROSS BLUE SHIELD
TX0077FAOtherBLUE CROSS BLUE SHIELD
TX00541PMedicare ID - Type Unspecified