Healthcare Provider Details

I. General information

NPI: 1285278341
Provider Name (Legal Business Name): THERESA NGOC HOANG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S PERRY ST STE 101B
CASTLE ROCK CO
80104-1921
US

IV. Provider business mailing address

801 S CHERRY ST APT 344
GLENDALE CO
80246-2654
US

V. Phone/Fax

Practice location:
  • Phone: 303-337-2020
  • Fax: 303-337-2053
Mailing address:
  • Phone: 316-518-2317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.0003496
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: