Basic Information
| Provider Information | |||||||||
| NPI: | 1285278341 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOANG | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | NGOC | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 S CHERRY ST APT 344 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802462654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3165182317 | ||||||||
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| Practice Location | |||||||||
| Address1: | 55 MADISON ST STE 355 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802065429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033772020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2019 | ||||||||
| LastUpdateDate: | 11/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPT.0003496 | CO | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.