Provider Demographics
NPI:1740272905
Name:HUYNH, ELIZABETH BC (OD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:BC
Last Name:HUYNH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:BINH
Other - Middle Name:CAM
Other - Last Name:HUYNH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 CAVALIER DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1357
Mailing Address - Country:US
Mailing Address - Phone:610-529-9536
Mailing Address - Fax:
Practice Address - Street 1:216 N 9TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1813
Practice Address - Country:US
Practice Address - Phone:215-922-6288
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001435152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012774430001Medicaid
U88734Medicare UPIN
PA1012774430001Medicaid