Provider Demographics
NPI:1609123561
Name:HUYNH, TERRY (OD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:HUYNH
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 1:485 CEDAR SAGE DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-2950
Mailing Address - Country:US
Mailing Address - Phone:972-681-7614
Mailing Address - Fax:
Practice Address - Street 1:1076 TOWN EAST MALL
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4179
Practice Address - Country:US
Practice Address - Phone:972-681-7614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7986TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist