Provider Demographics
NPI:1417961657
Name:HUFFMAN, TIMOTHY MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:HUFFMAN
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 1:4900 S ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-3515
Mailing Address - Country:US
Mailing Address - Phone:317-782-4000
Mailing Address - Fax:317-782-0998
Practice Address - Street 1:4900 S ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-3515
Practice Address - Country:US
Practice Address - Phone:317-782-4000
Practice Address - Fax:317-782-0998
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002698A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000323396OtherANTHEM
IN410035704OtherRR MEDICARE
IN138830AMedicare PIN
IN000000323396OtherANTHEM
INE51032Medicare UPIN
IN410035703Medicare PIN