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General NPI Number Information
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NPI Number | 1396748174
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Entity Type | Individual
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Provider Name | JAY L HUDDLESTON O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 12/29/2011
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Provider Practice Location Address
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Address Line | 1110 12TH ST
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City | ANACORTES
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State | WA
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Zip | 98221-2104
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Country | US
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Telephone | 360-293-9312
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Fax | 360-299-3937
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Provider Business Mailing Address
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Address Line | 1110 12TH ST
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City | ANACORTES
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State | WA
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Zip | 98221-2104
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Country | US
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Telephone | 360-293-9312
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Fax | 360-299-3937
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD00001311
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License Number State | WA
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