MEDICARE: DR. MICHAEL A HUANG OD,MS

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	152WL0500X	Low Vision Rehabilitation Optometrist	11658T	CA

General Provider Information

NPI Number	:	1548210883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL A HUANG OD,MS

Provider Business Mailing Address
First Line	:	8810 RIO SAN DIEGO DR
Second Line	:	112GZ
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-1622
Country	:	US
Telephone Number	:	619-400-5260
Fax Number	:	619-400-5263

Provider Business Practice Location Address
First Line	:	8810 RIO SAN DIEGO DR
Second Line	:	112GZ
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-1622
Country	:	US
Telephone Number	:	619-400-5260
Fax Number	:	619-400-5263

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	07/08/2007

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