Provider Demographics
NPI:1417443185
Name:HUANG, IRIS C (OD)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:C
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:PO BOX 899
Mailing Address - Street 2:
Mailing Address - City:ZUNI
Mailing Address - State:NM
Mailing Address - Zip Code:87327-0899
Mailing Address - Country:US
Mailing Address - Phone:510-213-8316
Mailing Address - Fax:
Practice Address - Street 1:12 B AVE
Practice Address - Street 2:OPTOMETRY CLINIC
Practice Address - City:ZUNI
Practice Address - State:NM
Practice Address - Zip Code:87327
Practice Address - Country:US
Practice Address - Phone:505-782-7485
Practice Address - Fax:505-782-7489
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003410152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist