Provider Demographics
NPI:1063123248
Name:KHANH NGO OD
Entity type:Organization
Organization Name:KHANH NGO OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:KHANH
Authorized Official - Middle Name:
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:312-810-3108
Mailing Address - Street 1:3878 S MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-0062
Mailing Address - Country:US
Mailing Address - Phone:312-810-3108
Mailing Address - Fax:
Practice Address - Street 1:13055 W RANCHO SANTA FE BLVD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-1700
Practice Address - Country:US
Practice Address - Phone:623-535-4215
Practice Address - Fax:623-535-4234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-08
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty