Healthcare Provider Details

I. General information

NPI: 1104137694
Provider Name (Legal Business Name): THOMAS MICHEAL HUFF O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 CLARK ST
ALAMOSA CO
81101-2050
US

IV. Provider business mailing address

719 CARSON ST
GREENEVILLE TN
37743-4703
US

V. Phone/Fax

Practice location:
  • Phone: 719-992-2121
  • Fax: 719-993-0155
Mailing address:
  • Phone: 719-298-1393
  • Fax: 423-638-7687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT002584
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3276
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2902
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: