Healthcare Provider Details

I. General information

NPI: 1245025816
Provider Name (Legal Business Name): KATHERINE NGO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 W EL PORTAL DR STE A
MERCED CA
95348-2850
US

IV. Provider business mailing address

197 W EL PORTAL DR STE A
MERCED CA
95348-2850
US

V. Phone/Fax

Practice location:
  • Phone: 209-384-2110
  • Fax: 209-384-8756
Mailing address:
  • Phone: 209-384-2110
  • Fax: 209-384-8756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36300
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: