Provider Demographics
NPI:1073514485
Name:HOANG, CHARLES (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:HOANG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 N RIDGELAND AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2218
Mailing Address - Country:US
Mailing Address - Phone:312-498-1755
Mailing Address - Fax:
Practice Address - Street 1:150 N MICHIGAN AVE
Practice Address - Street 2:STE. 650
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7553
Practice Address - Country:US
Practice Address - Phone:312-372-7571
Practice Address - Fax:312-372-7358
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009175152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009175Medicaid
U78524Medicare UPIN
IL567600Medicare ID - Type Unspecified