MEDICARE: DR. CHARLES HOANG O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	046009175	IL

General Provider Information

NPI Number	:	1073514485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES HOANG O.D.

Provider Business Mailing Address
First Line	:	416 N RIDGELAND AVE
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-2218
Country	:	US
Telephone Number	:	312-498-1755
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 N MICHIGAN AVE
Second Line	:	STE. 650
City	:	CHICAGO
State	:	IL
Zip	:	60601-7553
Country	:	US
Telephone Number	:	312-372-7571
Fax Number	:	312-372-7358

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	10/26/2016

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