Provider Demographics
NPI:1033366752
Name:HO, PHUONG KHANH THI (OD)
Entity Type:Individual
Prefix:MISS
First Name:PHUONG KHANH
Middle Name:THI
Last Name:HO
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 1:2138 RAMISH DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-2841
Mailing Address - Country:US
Mailing Address - Phone:408-646-8983
Mailing Address - Fax:
Practice Address - Street 1:1360 BURTON DR
Practice Address - Street 2:#150
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-3557
Practice Address - Country:US
Practice Address - Phone:707-446-6500
Practice Address - Fax:707-446-0154
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT13682T152W00000X
PAOEG002096152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist