Healthcare Provider Details

I. General information

NPI: 1336508381
Provider Name (Legal Business Name): VICTOR Y. HO, O.D. A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 W MARCH LN STE 211
STOCKTON CA
95219-6567
US

IV. Provider business mailing address

3031 W MARCH LN STE 211
STOCKTON CA
95219-6567
US

V. Phone/Fax

Practice location:
  • Phone: 209-272-7537
  • Fax: 209-272-7285
Mailing address:
  • Phone: 209-272-7537
  • Fax: 209-272-7285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10589T
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number10589T
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number10589T
License Number StateCA

VIII. Authorized Official

Name: DR. VICTOR YEP HO
Title or Position: OWNER
Credential: O.D.
Phone: 209-272-7537