Healthcare Provider Details

I. General information

NPI: 1194743351
Provider Name (Legal Business Name): JOHN P HUARD OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 E 1ST ST STE A
PORT ANGELES WA
98362-4020
US

IV. Provider business mailing address

240 W FRONT ST STE A
PORT ANGELES WA
98362-2609
US

V. Phone/Fax

Practice location:
  • Phone: 360-452-2020
  • Fax: 360-452-8087
Mailing address:
  • Phone: 360-452-2020
  • Fax: 360-452-8087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD00003184
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: