Provider Demographics
NPI:1962439265
Name:NGUYEN, HOA PHUONG (OD)
Entity Type:Individual
Prefix:DR
First Name:HOA PHUONG
Middle Name:
Last Name:NGUYEN
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 1:7155 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-1408
Mailing Address - Country:US
Mailing Address - Phone:619-315-0192
Mailing Address - Fax:
Practice Address - Street 1:7155 BROADWAY
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-1408
Practice Address - Country:US
Practice Address - Phone:619-315-0192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 12630T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
BB516ZOtherMEDICARE PTAN
CAV01402Medicare UPIN
BB516ZOtherMEDICARE PTAN