Provider Demographics
NPI:1518976448
Name:HUANG, CATHERINE (OD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
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 1:1001 W WHITTIER BLVD
Mailing Address - Street 2:STE E
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4688
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 W WHITTIER BLVD
Practice Address - Street 2:STE E
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4688
Practice Address - Country:US
Practice Address - Phone:323-278-9219
Practice Address - Fax:323-278-9219
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12302T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0123020Medicaid
CASD0123021Medicaid
CAOP12302Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
CAOP12302AMedicare ID - Type UnspecifiedMEDICARE PROVIDER ID
CASD0123021Medicaid