Healthcare Provider Details

I. General information

NPI: 1043575228
Provider Name (Legal Business Name): ANTHONY T HUYNH OD, FAAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 S CHICKASAW TRL
ORLANDO FL
32825
US

IV. Provider business mailing address

567 S CHICKASAW TRL
ORLANDO FL
32825-7801
US

V. Phone/Fax

Practice location:
  • Phone: 407-930-5566
  • Fax: 321-549-6242
Mailing address:
  • Phone: 407-930-5566
  • Fax: 321-549-6242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7991TG
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4783
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4783
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number4783
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number4783
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: