Provider Demographics
NPI:1336136134
Name:HUEY, DAVID M (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:HUEY
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 1:1425 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-2101
Mailing Address - Country:US
Mailing Address - Phone:580-477-1355
Mailing Address - Fax:580-477-1527
Practice Address - Street 1:1425 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-2101
Practice Address - Country:US
Practice Address - Phone:580-477-1355
Practice Address - Fax:580-477-1527
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2102152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100764340AMedicaid
OK100764340AMedicaid
OK$$$$$$$$$-001OtherBLUE CROSS/BLUE SHIELD
OK100764340AMedicaid