Healthcare Provider Details

I. General information

NPI: 1962246041
Provider Name (Legal Business Name): JACKY WANG HO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 01/18/2026
Certification Date: 01/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

979 STORY RD UNIT 7009
SAN JOSE CA
95122-4602
US

IV. Provider business mailing address

979 STORY RD UNIT 7009
SAN JOSE CA
95122-4602
US

V. Phone/Fax

Practice location:
  • Phone: 408-900-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number35894
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35894
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11106T
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number11106T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: