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General NPI Number Information
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NPI Number | 1942467238
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Entity Type | Organization
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Legal Business Name | COLLEGE GROVE OPTOMETRY
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 09/02/2010
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Provider Practice Location Address
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Address Line | 3408 COLLEGE AVE
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City | SAN DIEGO
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State | CA
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Zip | 92115-7134
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Country | US
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Telephone | 619-583-5744
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Fax | 619-583-5744
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Provider Business Mailing Address
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Address Line | 3408 COLLEGE AVE
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City | SAN DIEGO
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State | CA
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Zip | 92115-7134
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Country | US
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Telephone | 619-583-5744
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Fax | 619-583-5744
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HOA PHUONG T NGUYEN
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Credential | O.D.
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Telephone | 619-583-5744
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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 | 12630T
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License Number State | CA
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