Provider Demographics
NPI:1659344802
Name:HUANG, ANTHONY JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOSEPH
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 1:17100 NORWALK BLVD
Mailing Address - Street 2:STE 107
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2750
Mailing Address - Country:US
Mailing Address - Phone:562-867-8302
Mailing Address - Fax:
Practice Address - Street 1:14329 WOODRUFF AVE
Practice Address - Street 2:SUITE E
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-3260
Practice Address - Country:US
Practice Address - Phone:562-867-8302
Practice Address - Fax:562-867-7046
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10496T152W00000X
WA3217152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0104960Medicaid
OP10496Medicare ID - Type Unspecified
U58754Medicare UPIN
CAWOP10496MMedicare PIN