Provider Demographics
NPI:1619175692
Name:HOANG, VIVIAN B (OD)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:B
Last Name:HOANG
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 1:6410 INTERSTATE 45
Mailing Address - Street 2:
Mailing Address - City:LA MARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568-3085
Mailing Address - Country:US
Mailing Address - Phone:409-986-7907
Mailing Address - Fax:409-986-1016
Practice Address - Street 1:6410 INTERSTATE 45
Practice Address - Street 2:
Practice Address - City:LA MARQUE
Practice Address - State:TX
Practice Address - Zip Code:77568-3085
Practice Address - Country:US
Practice Address - Phone:409-986-7907
Practice Address - Fax:409-986-1016
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6014 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist