Provider Demographics
NPI:1689901076
Name:HUYNH, PHILLIP TRIEN (OD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:TRIEN
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 1:1729 TEESDALE ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-3808
Mailing Address - Country:US
Mailing Address - Phone:267-304-3576
Mailing Address - Fax:
Practice Address - Street 1:1729 TEESDALE ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19111-3808
Practice Address - Country:US
Practice Address - Phone:267-304-3576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002298152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist