Provider Demographics
NPI:1043575228
Name:HUYNH, ANTHONY T (OD, FAAO)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:T
Last Name:HUYNH
Suffix:
Gender:M
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 S CHICKASAW TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-7801
Mailing Address - Country:US
Mailing Address - Phone:407-930-5566
Mailing Address - Fax:321-549-6242
Practice Address - Street 1:567 S CHICKASAW TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825
Practice Address - Country:US
Practice Address - Phone:407-930-5566
Practice Address - Fax:321-549-6242
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7991TG152W00000X
FL4783152W00000X, 152WC0802X, 152WL0500X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1124091-04Medicaid
TX1124091-04Medicaid
TX00E63GMedicare UPIN