Provider Demographics
NPI:1477949311
Name:NGO, NOY
Entity Type:Individual
Prefix:
First Name:NOY
Middle Name:
Last Name:NGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 HAVENWOOD CT
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-9271
Mailing Address - Country:US
Mailing Address - Phone:510-325-9474
Mailing Address - Fax:
Practice Address - Street 1:1500 HELEN POWER DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-3506
Practice Address - Country:US
Practice Address - Phone:707-454-9493
Practice Address - Fax:707-449-8993
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-07
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT33458-TLG152W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program