Provider Demographics
NPI:1558354126
Name:HUEY, LES (OD)
Entity Type:Individual
Prefix:DR
First Name:LES
Middle Name:
Last Name:HUEY
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 1:2396 CRENSHAW BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-3336
Mailing Address - Country:US
Mailing Address - Phone:310-320-0081
Mailing Address - Fax:310-320-0082
Practice Address - Street 1:2396 CRENSHAW BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-3336
Practice Address - Country:US
Practice Address - Phone:310-320-0081
Practice Address - Fax:310-320-0082
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2012-03-06
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
CA5698T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0056980Medicaid
CASD0056980Medicaid