MEDICARE: STANLEY HUEY, O.D. & TINA H. FONG, O.D.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669557096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STANLEY HUEY, O.D. & TINA H. FONG, O.D.

Provider Business Mailing Address
First Line	:	12417 FAIR OAKS BLVD.
Second Line	:	SUITE 500
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-2558
Country	:	US
Telephone Number	:	916-722-4280
Fax Number	:	916-722-0148

Provider Business Practice Location Address
First Line	:	12417 FAIR OAKS BLVD
Second Line	:	SUITE 500
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-2501
Country	:	US
Telephone Number	:	916-722-4280
Fax Number	:	916-722-0148

Authorized Official
Title or Position	:	OPTOMETRIST/GENERAL PARTNER
Name	:	DR. TINA HUEY FONG
Credential	:	O.D.
Telephone Number	:	916-722-4280

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	12/02/2009

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