MEDICARE: MS. JESSICA THI HUYNH OD

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	152W00000X	Optometrist	5953	OH
2	152W00000X	Optometrist	14380	CA

General Provider Information

NPI Number	:	1477866531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA THI HUYNH OD

Provider Business Mailing Address
First Line	:	1737 DIAMOND WOODS CIR
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95747
Country	:	US
Telephone Number	:	916-335-9655
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 15TH STREET
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95818-2238
Country	:	US
Telephone Number	:	916-443-8034
Fax Number	:	916-442-6010

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2010
Last Update Date	:	05/31/2022

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