Provider Demographics
NPI:1245208511
Name:MAC, HUNG D (OD)
Entity Type:Individual
Prefix:DR
First Name:HUNG
Middle Name:D
Last Name:MAC
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 1:2534 BERRYESSA RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2903
Mailing Address - Country:US
Mailing Address - Phone:408-272-7200
Mailing Address - Fax:408-272-3310
Practice Address - Street 1:2534 BERRYESSA RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132-2903
Practice Address - Country:US
Practice Address - Phone:408-272-7200
Practice Address - Fax:408-272-3310
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12610T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV04320Medicare ID - Type Unspecified
CAV04320Medicare UPIN