Healthcare Provider Details

I. General information

NPI: 1659489771
Provider Name (Legal Business Name): SANDRA J HUFSMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2294 NW KINGS BLVD
CORVALLIS OR
97330-3923
US

IV. Provider business mailing address

2294 NW KINGS BLVD
CORVALLIS OR
97330-3923
US

V. Phone/Fax

Practice location:
  • Phone: 541-754-1415
  • Fax: 541-754-9848
Mailing address:
  • Phone: 541-754-1415
  • Fax: 541-754-9848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD13089
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: