Provider Demographics
NPI:1124154927
Name:HUEY, LARRY CY (OD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:CY
Last Name:HUEY
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 1:9174 FRANKLIN BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-5524
Mailing Address - Country:US
Mailing Address - Phone:916-422-1066
Mailing Address - Fax:916-422-1162
Practice Address - Street 1:9174 FRANKLIN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-5524
Practice Address - Country:US
Practice Address - Phone:916-422-1066
Practice Address - Fax:916-422-1162
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA12023T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0120231Medicare ID - Type Unspecified
CAU90138Medicare UPIN