Healthcare Provider Details

I. General information

NPI: 1417790023
Provider Name (Legal Business Name): ABIGAIL HOANG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 06/13/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 W MINERAL AVE STE 100
LITTLETON CO
80120-5716
US

IV. Provider business mailing address

7836 GAMBRILL WOODS WAY
SPRINGFIELD VA
22153-2260
US

V. Phone/Fax

Practice location:
  • Phone: 303-730-0404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.0004042
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: