Provider Demographics
NPI:1659489326
Name:HUGHES, MARTY (OD)
Entity Type:Individual
Prefix:
First Name:MARTY
Middle Name:
Last Name:HUGHES
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 1:312 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019
Mailing Address - Country:US
Mailing Address - Phone:901-476-8614
Mailing Address - Fax:901-475-1921
Practice Address - Street 1:312 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019
Practice Address - Country:US
Practice Address - Phone:901-476-8614
Practice Address - Fax:901-475-1921
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1891T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3113049OtherBCBS
TN3941840Medicaid
TN3941840Medicaid
U70121Medicare UPIN