Healthcare Provider Details

I. General information

NPI: 1861801177
Provider Name (Legal Business Name): MARISSA HUANG O.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 LEXINGTON AVE
NEW YORK NY
10028-1404
US

IV. Provider business mailing address

333 E 79TH ST APT 15W
NEW YORK NY
10075-0960
US

V. Phone/Fax

Practice location:
  • Phone: 646-757-2290
  • Fax: 646-417-7732
Mailing address:
  • Phone: 415-246-2376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number15444
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV008153-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: