Healthcare Provider Details

I. General information

NPI: 1053603688
Provider Name (Legal Business Name): KASEY J. HUFFMAN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MCNAUGHTEN RD SUITE 200
COLUMBUS OH
43213-2120
US

IV. Provider business mailing address

125 W NEW ENGLAND AVE
WORTHINGTON OH
43085-3537
US

V. Phone/Fax

Practice location:
  • Phone: 614-863-3937
  • Fax: 614-863-5010
Mailing address:
  • Phone: 614-505-1307
  • Fax: 614-863-5010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5113 T2012
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: