Healthcare Provider Details

I. General information

NPI: 1811007354
Provider Name (Legal Business Name): PHILIP DEAN HUFFMAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5135 DOVER CENTER RD
NORTH OLMSTED OH
44070-3128
US

IV. Provider business mailing address

5135 DOVER CENTER RD
NORTH OLMSTED OH
44070-3128
US

V. Phone/Fax

Practice location:
  • Phone: 440-777-2766
  • Fax: 440-777-2668
Mailing address:
  • Phone: 440-777-2766
  • Fax: 440-777-2668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3127
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: