Provider Demographics
NPI:1912032392
Name:NGO, UYEN THANH (OD)
Entity Type:Individual
Prefix:DR
First Name:UYEN
Middle Name:THANH
Last Name:NGO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:TARRRYN
Other - Middle Name:UYEN
Other - Last Name:NGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1155 N CAPITOL AVE
Mailing Address - Street 2:STE 180
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2570
Mailing Address - Country:US
Mailing Address - Phone:408-272-4446
Mailing Address - Fax:408-272-5324
Practice Address - Street 1:1155 N CAPITOL AVE
Practice Address - Street 2:STE 180
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132-2570
Practice Address - Country:US
Practice Address - Phone:408-272-4446
Practice Address - Fax:408-272-5324
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10814T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0108140Medicaid
CAU78255Medicare UPIN
CASD0108140Medicaid