Provider Demographics
NPI:1144412701
Name:DAREK HUGGETT OD & ASSOCIATES PC
Entity Type:Organization
Organization Name:DAREK HUGGETT OD & ASSOCIATES PC
Other - Org Name:SALEM EYE PROFESSIONALS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAREK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HUGGETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-391-9570
Mailing Address - Street 1:1469 CAPITOL ST NE
Mailing Address - Street 2:100
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-7875
Mailing Address - Country:US
Mailing Address - Phone:503-391-9570
Mailing Address - Fax:503-763-7230
Practice Address - Street 1:1469 CAPITOL ST NE
Practice Address - Street 2:100
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-7875
Practice Address - Country:US
Practice Address - Phone:503-391-9570
Practice Address - Fax:503-763-7230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3012ATI152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1558448753OtherINDIVIDUAL NPI
OR6214100001Medicare NSC
ORU-46277Medicare UPIN