Provider Demographics
NPI:1851424071
Name:HOANG, VANNA T (OD)
Entity Type:Individual
Prefix:DR
First Name:VANNA
Middle Name:T
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 1:15332 SUMMERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6866
Mailing Address - Country:US
Mailing Address - Phone:714-757-4747
Mailing Address - Fax:
Practice Address - Street 1:1232 S MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-5116
Practice Address - Country:US
Practice Address - Phone:714-757-4747
Practice Address - Fax:714-948-5959
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11892T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0011892Medicaid
CASD11892Medicaid
CASD0011892Medicaid