Healthcare Provider Details

I. General information

NPI: 1467856443
Provider Name (Legal Business Name): TUAN HO O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 BRANDON TOWN CENTER MALL
BRANDON FL
33511-4943
US

IV. Provider business mailing address

3266 BRIDGE HAVEN DR
WESLEY CHAPEL FL
33543-5498
US

V. Phone/Fax

Practice location:
  • Phone: 813-685-1935
  • Fax:
Mailing address:
  • Phone: 352-262-4446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number8546T
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC6161
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: