Provider Demographics
NPI:1467607523
Name:HUFFMAN FAMILY EYE CARE PC
Entity Type:Organization
Organization Name:HUFFMAN FAMILY EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:CHRIS KEVIN
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:678-324-4211
Mailing Address - Street 1:80 SEVEN HILLS BLVD
Mailing Address - Street 2:STE 305
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-0574
Mailing Address - Country:US
Mailing Address - Phone:678-324-4211
Mailing Address - Fax:678-324-4216
Practice Address - Street 1:80 SEVEN HILLS BLVD
Practice Address - Street 2:STE 305
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-0574
Practice Address - Country:US
Practice Address - Phone:678-324-4211
Practice Address - Fax:678-324-4216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1952152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA112980193AMedicaid
GAU89978Medicare UPIN
GA511G701056Medicare PIN