Provider Demographics
NPI:1558771808
Name:VANNA HOANG OD INC
Entity Type:Organization
Organization Name:VANNA HOANG OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VANNA
Authorized Official - Middle Name:T
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:OPTOMETRIST
Authorized Official - Phone:714-757-4747
Mailing Address - Street 1:1232 S MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-5116
Mailing Address - Country:US
Mailing Address - Phone:714-757-4747
Mailing Address - Fax:714-636-2465
Practice Address - Street 1:1232 S MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-5116
Practice Address - Country:US
Practice Address - Phone:714-757-4747
Practice Address - Fax:714-948-5959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11892T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU92347Medicare UPIN