MEDICARE: DR. JOSEPH HUANG O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT12304	CA
2	152W00000X	Optometrist	OD12304	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0OPT12304	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1386673895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH HUANG O.D.

Provider Business Mailing Address
First Line	:	3400 DATA DR
Second Line	:
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95670-7956
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1321 COTTONWOOD ST STE 202
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95695-5131
Country	:	US
Telephone Number	:	530-668-2600
Fax Number	:	530-668-9591

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	10/06/2023

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