Provider Demographics
NPI:1265557490
Name:HUYNH, CUONG NGOC (OD)
Entity type:Individual
Prefix:
First Name:CUONG
Middle Name:NGOC
Last Name:HUYNH
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 1:761 S MARINE CORPS DR
Mailing Address - Street 2:2020 VISION CENTER CEN TAM BLDG STE A1
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913
Mailing Address - Country:US
Mailing Address - Phone:671-646-3001
Mailing Address - Fax:671-649-3001
Practice Address - Street 1:761 S MARINE CORPS DR
Practice Address - Street 2:2020 VISION CENTER CEN TAM BLDG STE A1
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-646-3001
Practice Address - Fax:671-649-3001
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUOL028152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist