Provider Demographics
NPI:1003952722
Name:HUE, KENNETH JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:JOSEPH
Last Name:HUE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 AIRPORT PROFESSIONAL CENTER
Mailing Address - Street 2:1380 RT 286 HWY EAST
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701
Mailing Address - Country:US
Mailing Address - Phone:724-349-3800
Mailing Address - Fax:724-349-5790
Practice Address - Street 1:503 AIRPORT PROFESSIONAL CENTER
Practice Address - Street 2:1380 RT 286 HWY EAST
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701
Practice Address - Country:US
Practice Address - Phone:724-349-3800
Practice Address - Fax:724-349-5790
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000535152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007354910004Medicaid
PA081424Medicare ID - Type Unspecified
PA0007354910004Medicaid