=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407623721
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NOY NGO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2023
-----------------------------------------------------
Last Update Date | 12/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 HELEN POWER DR
-----------------------------------------------------
City | VACAVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95687-3506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-454-9493
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 412 HAVENWOOD CT
-----------------------------------------------------
City | VACAVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95688-9271
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax | 707-449-8993
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. NOY NGO
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 510-325-9474
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------