Provider Demographics
NPI:1790835585
Name:HO, SERENA DENISE (OD)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:DENISE
Last Name:HO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:17029 LASSEN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-1940
Mailing Address - Country:US
Mailing Address - Phone:312-525-7808
Mailing Address - Fax:760-341-3725
Practice Address - Street 1:72840 HIGHWAY 111
Practice Address - Street 2:PALM DESERT TOWN CENTER #F201
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3324
Practice Address - Country:US
Practice Address - Phone:760-341-6324
Practice Address - Fax:760-341-3725
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12583152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV01159Medicare UPIN
CASDO125830Medicare ID - Type Unspecified