MEDICARE: KHANH NGO OD

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	046.009930	IL
2	152W00000X	Optometrist	OPT-002643	AZ

General Provider Information

NPI Number	:	1851432504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHANH NGO OD

Provider Business Mailing Address
First Line	:	13055 W RANCHO SANTA FE BLVD
Second Line	:
City	:	AVONDALE
State	:	AZ
Zip	:	85392-1700
Country	:	US
Telephone Number	:	623-535-4215
Fax Number	:	623-535-4234

Provider Business Practice Location Address
First Line	:	13055 W RANCHO SANTA FE BLVD
Second Line	:
City	:	AVONDALE
State	:	AZ
Zip	:	85392-1700
Country	:	US
Telephone Number	:	623-535-4215
Fax Number	:	623-535-4234

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	06/27/2024

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