Provider Demographics
NPI:1780065813
Name:HUYNH, ANDY (OD)
Entity type:Individual
Prefix:DR
First Name:ANDY
Middle Name:
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 1:9 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-4015
Mailing Address - Country:US
Mailing Address - Phone:781-963-8448
Mailing Address - Fax:781-963-5289
Practice Address - Street 1:9 WARREN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-4015
Practice Address - Country:US
Practice Address - Phone:781-963-8448
Practice Address - Fax:781-963-5289
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00613152W00000X
MA5097152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist