Provider Demographics
NPI:1396442653
Name:HOM, VERONICA (OD)
Entity type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:
Last Name:HOM
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 1:3384 VERNON TER
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-4203
Mailing Address - Country:US
Mailing Address - Phone:650-776-4323
Mailing Address - Fax:
Practice Address - Street 1:57 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-2401
Practice Address - Country:US
Practice Address - Phone:650-593-1661
Practice Address - Fax:650-595-5203
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT35403TLG152WP0200X, 152WV0400X, 152W00000X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program