Provider Demographics
NPI:1063679421
Name:PETER D HUANG, O.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PETER D HUANG, O.D. A PROFESSIONAL CORPORATION
Other - Org Name:H STREET OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:D
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:619-422-0139
Mailing Address - Street 1:557 H ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4330
Mailing Address - Country:US
Mailing Address - Phone:619-422-0139
Mailing Address - Fax:619-422-0066
Practice Address - Street 1:557 H ST
Practice Address - Street 2:SUITE B
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4330
Practice Address - Country:US
Practice Address - Phone:619-422-0139
Practice Address - Fax:619-422-0066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA11659T332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4787430001Medicare NSC
CADM259AMedicare PIN