Healthcare Provider Details

I. General information

NPI: 1346226123
Provider Name (Legal Business Name): MICHAEL HUANG O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 N WATERMAN AVE SUITE 201
SAN BERNARDINO CA
92404-4811
US

IV. Provider business mailing address

2150 N WATERMAN AVE #201
SAN BERNARDINO CA
92404-4811
US

V. Phone/Fax

Practice location:
  • Phone: 909-881-2020
  • Fax:
Mailing address:
  • Phone: 909-881-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12699T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: