Provider Demographics
NPI:1053480491
Name:HO, ELVIN (OD)
Entity Type:Individual
Prefix:DR
First Name:ELVIN
Middle Name:
Last Name:HO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 N ESTRELLA PKWY
Mailing Address - Street 2:STE. B2, #480
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-4135
Mailing Address - Country:US
Mailing Address - Phone:480-626-5127
Mailing Address - Fax:480-240-1588
Practice Address - Street 1:4505 E MCKELLIPS RD
Practice Address - Street 2:VISION CENTER
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-2523
Practice Address - Country:US
Practice Address - Phone:480-626-5127
Practice Address - Fax:480-240-1588
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1165152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZV04752Medicare UPIN