Provider Demographics
NPI:1669557096
Name:STANLEY HUEY, O.D. & TINA H. FONG, O.D.
Entity type:Organization
Organization Name:STANLEY HUEY, O.D. & TINA H. FONG, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:HUEY
Authorized Official - Last Name:FONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:916-722-4280
Mailing Address - Street 1:12417 FAIR OAKS BLVD.
Mailing Address - Street 2:SUITE 500
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-2558
Mailing Address - Country:US
Mailing Address - Phone:916-722-4280
Mailing Address - Fax:916-722-0148
Practice Address - Street 1:12417 FAIR OAKS BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-2501
Practice Address - Country:US
Practice Address - Phone:916-722-4280
Practice Address - Fax:916-722-0148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0052200Medicaid
CA0379230001Medicare NSC
CAZZZ32867ZMedicare ID - Type UnspecifiedMEDICARE GROUP ID NUMBER
CAGR0052200Medicaid