Provider Demographics
NPI:1205029576
Name:HUA, RANDY (OD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:
Last Name:HUA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 N CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133-1938
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:872 FELLER AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-3515
Practice Address - Country:US
Practice Address - Phone:408-771-4998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2019-04-02
Deactivation Date:2018-09-05
Deactivation Code:
Reactivation Date:2019-03-04
Provider Licenses
StateLicense IDTaxonomies
CA13219T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist