Healthcare Provider Details

I. General information

NPI: 1629237466
Provider Name (Legal Business Name): EDWARD J HUGGETT JR OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4051 UPPER CREEK DR SUITE 107
SUN CITY CENTER FL
33573-6825
US

IV. Provider business mailing address

3608 ROCK ROYAL DR
HOLIDAY FL
34691-1133
US

V. Phone/Fax

Practice location:
  • Phone: 813-634-2266
  • Fax:
Mailing address:
  • Phone: 727-789-0199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOPC2447
License Number StateFL

VIII. Authorized Official

Name: DR. EDWARD JOSEPH HUGGETT JR.
Title or Position: PRESIDENT
Credential: O.D.
Phone: 727-789-0199