Provider Demographics
NPI:1285278341
Name:HOANG, THERESA NGOC (OD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:NGOC
Last Name:HOANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S CHERRY ST APT 344
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-2654
Mailing Address - Country:US
Mailing Address - Phone:316-518-2317
Mailing Address - Fax:
Practice Address - Street 1:55 MADISON ST STE 355
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5429
Practice Address - Country:US
Practice Address - Phone:303-377-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003496152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist