Provider Demographics
NPI:1679759849
Name:HUFFMAN, PETE CHRIS KEVIN (OD)
Entity Type:Individual
Prefix:DR
First Name:PETE
Middle Name:CHRIS KEVIN
Last Name:HUFFMAN
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 1:80 SEVEN HILLS BLVD
Mailing Address - Street 2:BLD 200
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-0574
Mailing Address - Country:US
Mailing Address - Phone:678-324-4211
Mailing Address - Fax:678-324-4216
Practice Address - Street 1:80 SEVEN HILLS BLVD
Practice Address - Street 2:BLD 200
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-0574
Practice Address - Country:US
Practice Address - Phone:678-324-4211
Practice Address - Fax:678-324-4216
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1952152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I410160Medicare PIN