Provider Demographics
NPI:1093763989
Name:HUGHES, J JEFFREY (OD)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:JEFFREY
Last Name:HUGHES
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 1:2855 NORTHPARK AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-9736
Mailing Address - Country:US
Mailing Address - Phone:260-356-6422
Mailing Address - Fax:260-356-6423
Practice Address - Street 1:2855 NORTHPARK AVE STE 104
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-9736
Practice Address - Country:US
Practice Address - Phone:260-356-6422
Practice Address - Fax:260-356-6423
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002003 B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1750559068OtherMEDICARE DME
IN100138100AMedicaid
INT34715Medicare UPIN
IN100138100AMedicaid
IN1750559068OtherMEDICARE DME