Provider Demographics
NPI:1366450967
Name:TUCKER, HOWARD WEBSTER JR (OD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:WEBSTER
Last Name:TUCKER
Suffix:JR
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 1:504 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-5720
Mailing Address - Country:US
Mailing Address - Phone:843-332-7171
Mailing Address - Fax:843-332-7802
Practice Address - Street 1:504 S 4TH ST
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-5720
Practice Address - Country:US
Practice Address - Phone:843-332-7171
Practice Address - Fax:843-332-7802
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC454152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist