Provider Demographics
NPI:1780163139
Name:HOANG, JOLYNN (OD)
Entity type:Individual
Prefix:DR
First Name:JOLYNN
Middle Name:
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 1:6131 PALOMONTE DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-8015
Mailing Address - Country:US
Mailing Address - Phone:361-935-6819
Mailing Address - Fax:
Practice Address - Street 1:3124 E CENTRAL TEXAS EXPY
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-7333
Practice Address - Country:US
Practice Address - Phone:254-690-4733
Practice Address - Fax:254-690-6728
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9464152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX395877902Medicaid