Provider Demographics
NPI:1528370905
Name:LA, NGOC-ANH (OD)
Entity Type:Individual
Prefix:
First Name:NGOC-ANH
Middle Name:
Last Name:LA
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 1:1010 28TH ST SW
Mailing Address - Street 2:SUITE 11B
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-2881
Mailing Address - Country:US
Mailing Address - Phone:616-538-0610
Mailing Address - Fax:
Practice Address - Street 1:1010 28TH ST SW
Practice Address - Street 2:SUITE 11B
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-2881
Practice Address - Country:US
Practice Address - Phone:616-538-0610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004585152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN34040108Medicare PIN
MIN26930204Medicare PIN