Provider Demographics
NPI:1376693408
Name:DOAN STEWART, HUYEN D (OD)
Entity Type:Individual
Prefix:DR
First Name:HUYEN
Middle Name:D
Last Name:DOAN STEWART
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KYM
Other - Middle Name:
Other - Last Name:DOAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:12721 MORENO BEACH DR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-4411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12721 MORENO BEACH DR
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-4411
Practice Address - Country:US
Practice Address - Phone:951-247-1341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10686T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0106860Medicare ID - Type Unspecified