Provider Demographics
NPI:1801821202
Name:HOANG, VANESSA TAN (OD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:TAN
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 1:939 W EL CAMINO REAL STE 116
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-1179
Mailing Address - Country:US
Mailing Address - Phone:408-739-0591
Mailing Address - Fax:408-739-0593
Practice Address - Street 1:939 W EL CAMINO REAL STE 116
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-1179
Practice Address - Country:US
Practice Address - Phone:408-739-0591
Practice Address - Fax:408-739-0593
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12425T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0124250Medicaid
CAV01420Medicare UPIN
CASD0124250Medicare ID - Type Unspecified