Provider Demographics
NPI:1467964627
Name:HOUGHTALING, ERIC LEE (LICENSED OPTIAN)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:LEE
Last Name:HOUGHTALING
Suffix:
Gender:M
Credentials:LICENSED OPTIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:NY
Mailing Address - Zip Code:14522-9118
Mailing Address - Country:US
Mailing Address - Phone:585-755-8704
Mailing Address - Fax:
Practice Address - Street 1:2180 MONROE AVE STE 1
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2410
Practice Address - Country:US
Practice Address - Phone:585-755-8545
Practice Address - Fax:585-755-8545
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008413-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist