Provider Demographics
NPI:1154473916
Name:HOM, GREGORY (OD, MPH)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:HOM
Suffix:
Gender:M
Credentials:OD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11230 SORRENTO VALLEY RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1332
Mailing Address - Country:US
Mailing Address - Phone:858-535-9835
Mailing Address - Fax:858-535-1266
Practice Address - Street 1:11230 SORRENTO VALLEY RD
Practice Address - Street 2:SUITE 115
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1332
Practice Address - Country:US
Practice Address - Phone:858-535-9835
Practice Address - Fax:858-535-1266
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9694T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist