Healthcare Provider Details

I. General information

NPI: 1326470196
Provider Name (Legal Business Name): ANTHONY BLAKE HUTTO O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 E 16TH ST
ALMA GA
31510-3008
US

IV. Provider business mailing address

410 E 16TH ST
ALMA GA
31510-3008
US

V. Phone/Fax

Practice location:
  • Phone: 912-632-7623
  • Fax: 912-632-5816
Mailing address:
  • Phone: 912-632-7623
  • Fax: 912-632-5816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT002764
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: