Provider Demographics
NPI:1366502718
Name:HO, THUY N (OD)
Entity Type:Individual
Prefix:
First Name:THUY
Middle Name:N
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 1:6641 GRAND AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5262
Mailing Address - Country:US
Mailing Address - Phone:847-856-1200
Mailing Address - Fax:847-856-8526
Practice Address - Street 1:6641 GRAND AVENUE
Practice Address - Street 2:SUITE D
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-4502
Practice Address - Country:US
Practice Address - Phone:847-856-1200
Practice Address - Fax:847-856-8526
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL46-009026152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL173891Medicare UPIN
IL579260100Medicare PIN