Healthcare Provider Details

I. General information

NPI: 1649019209
Provider Name (Legal Business Name): JIAWEN HUO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 E MANNING AVE
PARLIER CA
93648-2668
US

IV. Provider business mailing address

490 ILLINOIS ST
SAN FRANCISCO CA
94158
US

V. Phone/Fax

Practice location:
  • Phone: 800-492-4227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT35748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: