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NPI Code Detail

MEDICARE: JOANNE C. GWO O.D.

MEDICARE: JOANNE C. GWO 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
1152W00000XOptometristOPT14201TLGCA

General Provider Information

NPI Number : 1083900336
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOANNE C. GWO O.D.
Provider Business Mailing Address
First Line : 2010 EL CAMINO REAL # 336
Second Line :
City : SANTA CLARA
State : CA
Zip : 95050-4051
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1600 EL CAMINO REAL
Second Line : OPTOMETRY DEPARTMENT
City : SOUTH SAN FRANCISCO
State : CA
Zip : 94080-1206
Country : US
Telephone Number : 650-992-5881
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2011
Last Update Date : 08/24/2022

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