Individual provider Active NPI

Hoang Minh Ho, O.D.

  • Optometrist
  • San Diego, CA
National Provider Identifier
1275684847
Registry record updated Jan 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
12582TPA Issued in CA
Practice address
4840 Shawline St
San Diego, CA 92111-1400
Phone
(858) 560-5742
Fax
(858) 569-6596
NPI assigned
Jan 12, 2007
Last updated
Jan 11, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 12582TPA CA Primary

Addresses

Primary practice location

4840 Shawline St
San Diego, CA 92111-1400

Mailing address

4840 Shawline St
San Diego, CA 92111-1400
Phone (858) 560-5742

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040930000689 CA Practitioner - Optometry 7214906759 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12582CAMDDental Hygienist
12582TPACAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Hoang Minh Ho, O.D, Inc Optometrist CurrentSince Jun 12, 2025 Accepting new patients
Legacy MD Medical Group Inc CurrentSince Jan 7, 2024 Accepting new patients
Imperial Manor Skilled Nursing Inc CurrentSince Aug 10, 2024 Accepting new patients
Legacy MD Medical Group Inc PastSince May 28, 2024 Accepting new patients

Locations

290 Main St
Brawley, CA 92227
Phone (760) 352-2551

222 E Cole Blvd
Calexico, CA 92231
Phone (760) 352-2551

222 E Cole Blvd
Ste C
Calexico, CA 92231
Phone (760) 352-2551

690 Otay Lakes Rd
Ste 125
Chula Vista, CA 91910
Phone (760) 352-2551

1520 S Imperial Ave
El Centro, CA 92243
Phone (760) 352-2551

81812 Doctor Carreon Blvd
Ste E
Indio, CA 92201
Phone (442) 236-1498

10737 Camino Ruiz
Ste 220
San Diego, CA 92126
Phone (619) 881-4587

4840 Shawline St
San Diego, CA 92111
Phone (858) 268-7840

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641859200000",
    "number": "1275684847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4840 SHAWLINE ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921111400",
            "telephone_number": "858-560-5742",
            "fax_number": "858-569-6596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4840 SHAWLINE ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921111400",
            "telephone_number": "858-560-5742",
            "fax_number": "858-569-6596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HO",
        "first_name": "HOANG",
        "middle_name": "MINH",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-12",
        "last_updated": "2022-01-11",
        "certification_date": "2022-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "12582TPA",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.