Provider Demographics
NPI:1548230964
Name:HUET, MICHAEL DAVID (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:HUET
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 1:1155 WASHINGTON PIKE
Mailing Address - Street 2:SUITE 77
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-2827
Mailing Address - Country:US
Mailing Address - Phone:412-221-7007
Mailing Address - Fax:412-220-8163
Practice Address - Street 1:1155 WASHINGTON PIKE
Practice Address - Street 2:SUITE 77
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-2827
Practice Address - Country:US
Practice Address - Phone:412-221-7007
Practice Address - Fax:412-220-8163
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000304152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01780710Medicaid
PA034399QW3Medicare PIN
PA01780710Medicaid