Provider Demographics
NPI:1841330263
Name:HOANG, BAO (OD)
Entity type:Individual
Prefix:DR
First Name:BAO
Middle Name:
Last Name:HOANG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 PRESTON ROAD
Mailing Address - Street 2:SUITE 2124
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-9434
Mailing Address - Country:US
Mailing Address - Phone:972-335-9529
Mailing Address - Fax:
Practice Address - Street 1:2601 PRESTON ROAD
Practice Address - Street 2:SUITE 2124
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9434
Practice Address - Country:US
Practice Address - Phone:999-999-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06828152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB114652Medicare PIN