Healthcare Provider Details

I. General information

NPI: 1801314794
Provider Name (Legal Business Name): KATIE HOANG MIAO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE HOANG-MIAO OD

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 N NARRAGANSETT AVE
CHICAGO IL
60639-1083
US

IV. Provider business mailing address

474 N LAKE SHORE DR APT 4005
CHICAGO IL
60611-6483
US

V. Phone/Fax

Practice location:
  • Phone: 773-622-2405
  • Fax:
Mailing address:
  • Phone: 312-833-1605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12715650-9934
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT003405
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number113143
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046.011148
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1986932AT
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: