Provider Demographics
NPI:1881021186
Name:VO, THERESA PHUONG ANH (OD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:PHUONG ANH
Last Name:VO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:VO
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:970 MACKENZIE CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127
Mailing Address - Country:US
Mailing Address - Phone:800-813-2000
Mailing Address - Fax:
Practice Address - Street 1:970 MACKENZIE CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127
Practice Address - Country:US
Practice Address - Phone:408-646-6102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002946152W00000X
NY009299152W00000X
WAOD60484194152W00000X
PAOEG002864152W00000X
MO2020026442152W00000X
NJ27OA00704900152W00000X
WI20453-875152W00000X
FLTPOP35152W00000X
IA101325152W00000X
OR4353152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist