Provider Demographics
NPI:1558448753
Name:HUGGETT, DAREK ALLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:DAREK
Middle Name:ALLEN
Last Name:HUGGETT
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 1:1469 CAPITOL ST NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-7875
Mailing Address - Country:US
Mailing Address - Phone:503-391-9570
Mailing Address - Fax:503-763-7230
Practice Address - Street 1:1469 CAPITOL NE
Practice Address - Street 2:100
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-7875
Practice Address - Country:US
Practice Address - Phone:503-391-9570
Practice Address - Fax:503-763-7230
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3012ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OROR3012OtherEYEMED
ORU-46277Medicare UPIN
ORR117683Medicare PIN
ORR117683Medicare PIN