Provider Demographics
NPI:1043282171
Name:HUGHEY, CAMDA MARIE (OD)
Entity Type:Individual
Prefix:
First Name:CAMDA
Middle Name:MARIE
Last Name:HUGHEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CAMDA
Other - Middle Name:MARIE
Other - Last Name:TEMMEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1505 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MT ZION
Mailing Address - State:IL
Mailing Address - Zip Code:62549-1300
Mailing Address - Country:US
Mailing Address - Phone:217-864-3221
Mailing Address - Fax:217-864-3345
Practice Address - Street 1:867 PEACHTREE ST NE STE 2
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1902
Practice Address - Country:US
Practice Address - Phone:470-823-4375
Practice Address - Fax:678-949-9965
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008630152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U43620Medicare UPIN
ILU43620Medicare ID - Type Unspecified
IL240670Medicare ID - Type Unspecified