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NPI Code Detail

MEDICARE: COLLEGE GROVE OPTOMETRY

MEDICARE: COLLEGE GROVE OPTOMETRY
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
1152W00000XOptometrist12630TCA

General Provider Information

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

Similar Medicare Providers

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Practice Fax:
1891842399 — DR. USHA HARI O.D.
Practice Location Address:
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Practice Fax:
1922294610 — NADIRA TALIB O.D.
Practice Location Address:
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1972783231 — FIRSTSIGHT VISION SERVICES, INC.
Practice Location Address:
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Directions to “COLLEGE GROVE OPTOMETRY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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