Provider Demographics
NPI:1174636872
Name:HUYNH, HOLLIE H (OD)
Entity Type:Individual
Prefix:DR
First Name:HOLLIE
Middle Name:H
Last Name:HUYNH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:11893 VALLEY VIEW ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-1236
Mailing Address - Country:US
Mailing Address - Phone:714-373-2020
Mailing Address - Fax:714-373-2015
Practice Address - Street 1:11893 VALLEY VIEW ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-1236
Practice Address - Country:US
Practice Address - Phone:714-373-2020
Practice Address - Fax:714-373-2015
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12586T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV01405Medicare UPIN
CA6368290001Medicare NSC