Healthcare Provider Details

I. General information

NPI: 1790291565
Provider Name (Legal Business Name): ANDREW M VO OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2017
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR
SAN DIEGO CA
92103
US

IV. Provider business mailing address

5460 E LA PALMA AVE
ANAHEIM CA
92807-2023
US

V. Phone/Fax

Practice location:
  • Phone: 858-534-6290
  • Fax:
Mailing address:
  • Phone: 714-463-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number33869
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number33869
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: