Provider Demographics
NPI:1629237466
Name:EDWARD J HUGGETT JR OD PA
Entity Type:Organization
Organization Name:EDWARD J HUGGETT JR OD PA
Other - Org Name:HUGGETT VISION THERAPY INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HUGGETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:727-789-0199
Mailing Address - Street 1:3608 ROCK ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-1133
Mailing Address - Country:US
Mailing Address - Phone:727-789-0199
Mailing Address - Fax:
Practice Address - Street 1:4051 UPPER CREEK DR
Practice Address - Street 2:SUITE 107
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-6825
Practice Address - Country:US
Practice Address - Phone:813-634-2266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2447152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078857100Medicaid
FL20231OtherBLUE CROSS BLUE SHIELD OF FLORIDA
FL20231SMedicare PIN
FL078857100Medicaid