Provider Demographics
NPI:1467890517
Name:HUFFMAN, HANNAH CHRISTAN (OD)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:CHRISTAN
Last Name:HUFFMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-1217
Mailing Address - Country:US
Mailing Address - Phone:606-877-1877
Mailing Address - Fax:606-878-9543
Practice Address - Street 1:503 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1217
Practice Address - Country:US
Practice Address - Phone:606-877-1877
Practice Address - Fax:606-878-9543
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1915DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100252890Medicaid
KYK103400Medicare PIN