Provider Demographics
NPI:1922199983
Name:NGO, DIANA (OD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:NGO
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 1:1343 S VOSS RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-1023
Mailing Address - Country:US
Mailing Address - Phone:713-722-9066
Mailing Address - Fax:713-722-0690
Practice Address - Street 1:1343 S VOSS RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-1023
Practice Address - Country:US
Practice Address - Phone:713-722-9066
Practice Address - Fax:713-722-0690
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5829T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU91199Medicare UPIN
TX8F0506Medicare PIN
8572B8Medicare PIN
TX5452100001Medicare ID - Type UnspecifiedPALMETTO