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General NPI Number Information
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NPI Number | 1538368394
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Entity Type | Organization
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Legal Business Name | DR DAVID HUSTON OD PA
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 04/26/2021
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Provider Practice Location Address
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Address Line | 2101 S HIGHWAY 77
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City | LYNN HAVEN
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State | FL
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Zip | 32444-4631
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Country | US
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Telephone | 850-271-3004
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Fax | 850-265-2607
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Provider Business Mailing Address
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Address Line | PO BOX 2112
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City | LYNN HAVEN
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State | FL
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Zip | 32444-8112
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Country | US
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Telephone | 850-419-3559
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Fax | 850-265-2607
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID E HUSTON
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Credential | O.D.
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Telephone | 850-419-3559
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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 | OPC 4138
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License Number State | FL
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