Healthcare Provider Details

I. General information

NPI: 1699832980
Provider Name (Legal Business Name): DOUGLAS L HUFF O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 S NEW BALLAS RD SUITE 129 EAST
SAINT LOUIS MO
63141-8705
US

IV. Provider business mailing address

777 S NEW BALLAS RD SUITE 129 EAST
SAINT LOUIS MO
63141-8705
US

V. Phone/Fax

Practice location:
  • Phone: 314-997-3833
  • Fax: 314-997-6329
Mailing address:
  • Phone: 314-997-3833
  • Fax: 314-997-6329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTO2489
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: