Provider Demographics
NPI:1639100522
Name:HUANG, PETER D (OD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:D
Last Name:HUANG
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 1:557 H ST
Mailing Address - Street 2:STE B
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4340
Mailing Address - Country:US
Mailing Address - Phone:619-422-0139
Mailing Address - Fax:
Practice Address - Street 1:557 H ST
Practice Address - Street 2:STE B
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4340
Practice Address - Country:US
Practice Address - Phone:619-422-0139
Practice Address - Fax:619-422-0066
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11659TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0116590Medicaid
CAOP11659Medicare ID - Type Unspecified
CASD0116590Medicaid
CA4787430001Medicare NSC
CADM269ZMedicare PIN