Organization
COLLEGE GROVE OPTOMETRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HOA PHUONG NGUYEN O.D. (CEO)
(619) 957-0443
Entity
Organization
Contact information
Practice address
3408 COLLEGE AVE, SAN DIEGO, CA 92115-7134
(619) 957-0443
Mailing address
3408 COLLEGE AVE, SAN DIEGO, CA 92115-7134
(619) 957-0443
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0126300
—
CA
Enumeration date
04/27/2010
Last updated
09/15/2010
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