Provider Demographics
NPI:1245419381
Name:HUSSEY, ERIC S (OD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:S
Last Name:HUSSEY
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:PO BOX 28104
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99228-8104
Mailing Address - Country:US
Mailing Address - Phone:509-467-4884
Mailing Address - Fax:509-326-0426
Practice Address - Street 1:25 W NORA AVE
Practice Address - Street 2:#101
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-4844
Practice Address - Country:US
Practice Address - Phone:509-326-2707
Practice Address - Fax:509-326-0426
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1090152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2075208Medicaid
WA2075208Medicaid
T86887Medicare UPIN