Provider Demographics
NPI:1497856900
Name:HUFF, KEVIN M (OD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:HUFF
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2450 E BEARDSLEY RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-1300
Mailing Address - Country:US
Mailing Address - Phone:602-482-1200
Mailing Address - Fax:602-482-1212
Practice Address - Street 1:2450 E BEARDSLEY RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-1300
Practice Address - Country:US
Practice Address - Phone:602-482-1200
Practice Address - Fax:602-482-1212
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2024-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1378152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ151894Medicare PIN
AZZ109198Medicare PIN
V00919Medicare UPIN
AZZ104729Medicare PIN