Provider Demographics
NPI:1578656153
Name:HOM, PATRICIA NGUYEN (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:NGUYEN
Last Name:HOM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:ANH-THU
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1080 S. WHITE ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-3821
Mailing Address - Country:US
Mailing Address - Phone:408-272-3002
Mailing Address - Fax:408-272-0820
Practice Address - Street 1:1080 S. WHITE ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-3821
Practice Address - Country:US
Practice Address - Phone:408-272-3002
Practice Address - Fax:408-272-0820
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11004T152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0110040Medicaid
CAMH2085036OtherDEA
CASD0110040Medicaid