Provider Demographics
NPI:1902341837
Name:DO, VAN (OD)
Entity Type:Individual
Prefix:DR
First Name:VAN
Middle Name:
Last Name:DO
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 1:7009 ALMEDA RD
Mailing Address - Street 2:222
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2175
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7009 ALMEDA RD
Practice Address - Street 2:222
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2175
Practice Address - Country:US
Practice Address - Phone:214-908-1602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-02
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8958152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist