Provider Demographics
NPI:1073248399
Name:HO, TINA (OD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
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 1:2270 S ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-7124
Mailing Address - Country:US
Mailing Address - Phone:805-722-5788
Mailing Address - Fax:
Practice Address - Street 1:2270 S ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-7124
Practice Address - Country:US
Practice Address - Phone:805-722-5788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILTBA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist