Provider Demographics
NPI:1225148570
Name:HUFF, KRISTAN LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTAN
Middle Name:LEE
Last Name:HUFF
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 W DAVID RD
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1811
Mailing Address - Country:US
Mailing Address - Phone:937-296-1444
Mailing Address - Fax:
Practice Address - Street 1:4021 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-2413
Practice Address - Country:US
Practice Address - Phone:937-293-2149
Practice Address - Fax:937-395-9633
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH4940152W00000X
CAT13132152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist