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General NPI Number Information
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NPI Number | 1568721413
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Entity Type | Organization
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Legal Business Name | ROBERT HOUGHTELING, O.D., P.C.
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Dates
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Enumeration Date | 05/14/2012
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Last Update Date | 05/14/2012
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Provider Practice Location Address
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Address Line | 1601 HWY 40 E SUITE N
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City | KINGSLAND
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State | GA
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Zip | 31548-6500
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Country | US
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Telephone | 912-729-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 HWY 40 E SUITE N
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City | KINGSLAND
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State | GA
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Zip | 31548-6500
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Country | US
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Telephone | 912-729-8300
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT HOUGHTELING
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Credential |
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Telephone | 912-729-8300
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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 |
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License Number State |
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