Healthcare Provider Details

I. General information

NPI: 1174357321
Provider Name (Legal Business Name): THUY TRAM LE HOANG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

598 TUCKAHOE RD
YONKERS NY
10710-5713
US

IV. Provider business mailing address

598 TUCKAHOE RD
YONKERS NY
10710-5713
US

V. Phone/Fax

Practice location:
  • Phone: 914-586-3937
  • Fax:
Mailing address:
  • Phone: 914-586-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number011055
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: