MEDICARE: HUYNH VISION SERVICES INC PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist
2	152W00000X	Optometrist

General Provider Information

NPI Number	:	1427693621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUYNH VISION SERVICES INC PC

Provider Business Mailing Address
First Line	:	1405 W BERRY ST
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76110-3814
Country	:	US
Telephone Number	:	817-923-3653
Fax Number	:	817-921-9599

Provider Business Practice Location Address
First Line	:	1405 W BERRY ST
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76110-3814
Country	:	US
Telephone Number	:	817-923-3653
Fax Number	:	817-921-9599

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TAI ANH HUYNH
Credential	:	OD
Telephone Number	:	817-923-3653

Provider Enumeration Date	:	11/12/2019
Last Update Date	:	11/12/2019

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