Provider Demographics
NPI:1174797856
Name:HA, NAM HOANG (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:NAM
Middle Name:HOANG
Last Name:HA
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
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Mailing Address - Street 1:1830 TOWN CENTER DR STE 210
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3236
Mailing Address - Country:US
Mailing Address - Phone:571-323-0980
Mailing Address - Fax:571-323-0981
Practice Address - Street 1:1830 TOWN CENTER DR STE 210
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3236
Practice Address - Country:US
Practice Address - Phone:571-323-0980
Practice Address - Fax:571-323-0981
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101002908156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician