Provider Demographics
NPI:1205322351
Name:HUYNH, THIEN DUC (OD)
Entity type:Individual
Prefix:
First Name:THIEN DUC
Middle Name:
Last Name:HUYNH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:COREY
Other - Middle Name:
Other - Last Name:HUYNH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2211 E SOUTHLAKE BLVD
Mailing Address - Street 2:#575
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092
Mailing Address - Country:US
Mailing Address - Phone:817-873-6810
Mailing Address - Fax:727-873-0944
Practice Address - Street 1:2211 E SOUTHLAKE BLVD
Practice Address - Street 2:#575
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092
Practice Address - Country:US
Practice Address - Phone:817-873-6810
Practice Address - Fax:727-873-0944
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC550152W00000X
TX10087152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist