1669557096 NPI number — STANLEY HUEY, O.D. & TINA H. FONG, O.D.

Table of content: (NPI 1669557096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669557096 NPI number — STANLEY HUEY, O.D. & TINA H. FONG, O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STANLEY HUEY, O.D. & TINA H. FONG, O.D.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669557096
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12417 FAIR OAKS BLVD.
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
FAIR OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95628-2558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-722-4280
Provider Business Mailing Address Fax Number:
916-722-0148

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12417 FAIR OAKS BLVD
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
FAIR OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95628-2501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-722-4280
Provider Business Practice Location Address Fax Number:
916-722-0148
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FONG
Authorized Official First Name:
TINA
Authorized Official Middle Name:
HUEY
Authorized Official Title or Position:
OPTOMETRIST/GENERAL PARTNER
Authorized Official Telephone Number:
916-722-4280

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GR0052200 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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