Provider Demographics
NPI:1710337365
Name:HOUSTON, JOSHUA
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:HOUSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15107 ABINGTON RIDGE PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-5269
Mailing Address - Country:US
Mailing Address - Phone:740-396-0528
Mailing Address - Fax:
Practice Address - Street 1:1030 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-2354
Practice Address - Country:US
Practice Address - Phone:812-282-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003969A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN18003969AOtherINDIANA OPTOMETRIST LICENSE NUMBER