Provider Demographics
NPI:1275684847
Name:HO, HOANG MINH (OD)
Entity Type:Individual
Prefix:
First Name:HOANG
Middle Name:MINH
Last Name:HO
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 1:4840 SHAWLINE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1400
Mailing Address - Country:US
Mailing Address - Phone:858-560-5742
Mailing Address - Fax:858-569-6596
Practice Address - Street 1:4840 SHAWLINE ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1400
Practice Address - Country:US
Practice Address - Phone:858-560-5742
Practice Address - Fax:858-569-6596
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12582TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP12582Medicare ID - Type Unspecified
CAV01406Medicare UPIN