Healthcare Provider Details

I. General information

NPI: 1639100522
Provider Name (Legal Business Name): PETER D HUANG O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 H ST STE B
CHULA VISTA CA
91910-4340
US

IV. Provider business mailing address

557 H ST STE B
CHULA VISTA CA
91910-4340
US

V. Phone/Fax

Practice location:
  • Phone: 619-422-0139
  • Fax: 619-422-0066
Mailing address:
  • Phone: 619-422-0139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11659TPL
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: