Provider Demographics
NPI:1275925281
Name:HOUGH, MAUDE
Entity Type:Individual
Prefix:MRS
First Name:MAUDE
Middle Name:
Last Name:HOUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 NW 6TH ST STE 2C
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-4197
Mailing Address - Country:US
Mailing Address - Phone:352-377-0532
Mailing Address - Fax:352-338-8001
Practice Address - Street 1:4605 NW 6TH ST STE 2C
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-4197
Practice Address - Country:US
Practice Address - Phone:352-377-0532
Practice Address - Fax:352-338-8001
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO5019156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL630303001Medicaid
FL1225153455OtherNPI
FL1720232648OtherNPI
FL630303000Medicaid