Provider Demographics
NPI:1609917954
Name:HUNT, PHILIP (OD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:HUNT
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 1:3700 RIVERTOWN PKWY SW
Mailing Address - Street 2:SP 2112
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-3085
Mailing Address - Country:US
Mailing Address - Phone:616-249-7362
Mailing Address - Fax:616-249-7362
Practice Address - Street 1:3700 RIVERTOWN PKWY SW
Practice Address - Street 2:SP 2112
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-3085
Practice Address - Country:US
Practice Address - Phone:616-249-7362
Practice Address - Fax:616-249-7362
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004059152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN26930082Medicare PIN
MIU87866Medicare UPIN