Healthcare Provider Details

I. General information

NPI: 1467607523
Provider Name (Legal Business Name): HUFFMAN FAMILY EYE CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 08/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEVEN HILLS BLVD STE 305
DALLAS GA
30132-0574
US

IV. Provider business mailing address

80 SEVEN HILLS BLVD STE 305
DALLAS GA
30132-0574
US

V. Phone/Fax

Practice location:
  • Phone: 678-324-4211
  • Fax: 678-324-4216
Mailing address:
  • Phone: 678-324-4211
  • Fax: 678-324-4216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1952
License Number StateGA

VIII. Authorized Official

Name: DR. PETER CHRIS KEVIN HUFFMAN
Title or Position: PRESIDENT
Credential: OD
Phone: 678-324-4211