Healthcare Provider Details

I. General information

NPI: 1578656153
Provider Name (Legal Business Name): PATRICIA NGUYEN HOM O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA ANH-THU NGUYEN O.D.

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 S. WHITE ROAD SUITE A
SAN JOSE CA
95127-3821
US

IV. Provider business mailing address

1080 S. WHITE ROAD SUITE A
SAN JOSE CA
95127-3821
US

V. Phone/Fax

Practice location:
  • Phone: 408-272-3002
  • Fax: 408-272-0820
Mailing address:
  • Phone: 408-272-3002
  • Fax: 408-272-0820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11004T
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number11004T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: