Provider Demographics
NPI:1447203781
Name:HUMPHREY, DONALD P (OD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:P
Last Name:HUMPHREY
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 1:407 N PLANT AVE
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-7247
Mailing Address - Country:US
Mailing Address - Phone:813-754-4558
Mailing Address - Fax:813-752-1789
Practice Address - Street 1:407 N PLANT AVE
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-7247
Practice Address - Country:US
Practice Address - Phone:813-754-4558
Practice Address - Fax:813-752-1789
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 1158152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084914600Medicaid
FL084914601Medicaid
T84087Medicare UPIN
19646AMedicare ID - Type Unspecified
FL084914600Medicaid