Healthcare Provider Details

I. General information

NPI: 1649950924
Provider Name (Legal Business Name): EMILY HAO-SHAN HUANG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 10/15/2024
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N VERMONT AVE FL 6
LOS ANGELES CA
90027-5337
US

IV. Provider business mailing address

245 OAKLAND RD
GLENDORA CA
91741-6410
US

V. Phone/Fax

Practice location:
  • Phone: 800-954-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35532TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: