Provider Demographics
NPI:1689927444
Name:XUSHAO HUANG OD INC
Entity Type:Organization
Organization Name:XUSHAO HUANG OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:XUSHAO
Authorized Official - Middle Name:
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-758-0965
Mailing Address - Street 1:74539 MOSS ROSE DR
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-3132
Mailing Address - Country:US
Mailing Address - Phone:626-758-0965
Mailing Address - Fax:760-841-5403
Practice Address - Street 1:46883 MONROE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5547
Practice Address - Country:US
Practice Address - Phone:760-600-7200
Practice Address - Fax:760-841-0543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13213152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty