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General NPI Number Information
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NPI Number | 1033366752
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Entity Type | Individual
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Provider Name | PHUONG KHANH THI HO O.D
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Gender | Female
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Dates
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Enumeration Date | 08/25/2008
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 1360 BURTON DR #150
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City | VACAVILLE
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State | CA
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Zip | 95687-3557
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Country | US
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Telephone | 707-446-6500
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Fax | 707-446-0154
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Provider Business Mailing Address
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Address Line | 2138 RAMISH DR
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City | SAN JOSE
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State | CA
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Zip | 95131-2841
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Country | US
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Telephone | 408-646-8983
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT13682T
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG002096
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License Number State | PA
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