Provider Demographics
NPI:1164576039
Name:HUANG, JUDY CHIEN WEI LAI (OD)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:CHIEN WEI LAI
Last Name:HUANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11525 E SOUTH ST
Mailing Address - Street 2:TARGET OPTICAL
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703
Mailing Address - Country:US
Mailing Address - Phone:562-924-7600
Mailing Address - Fax:562-274-0068
Practice Address - Street 1:11525 E SOUTH ST
Practice Address - Street 2:TARGET OPTICAL
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703
Practice Address - Country:US
Practice Address - Phone:562-924-7600
Practice Address - Fax:562-274-0068
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 12155 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U96634Medicare UPIN
OP12155Medicare PIN