Provider Demographics
NPI:1619461506
Name:HOANG, QUY
Entity Type:Individual
Prefix:
First Name:QUY
Middle Name:
Last Name:HOANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 N PLANO RD
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-3827
Mailing Address - Country:US
Mailing Address - Phone:469-567-3640
Mailing Address - Fax:469-567-3737
Practice Address - Street 1:159 N PLANO RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-3827
Practice Address - Country:US
Practice Address - Phone:469-567-3640
Practice Address - Fax:469-567-3737
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008770TUV152W00000X
PAOEG003513152W00000X
TX9752TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX411857201Medicaid
TX411856401Medicaid
TX433863401Medicaid