Provider Demographics
NPI:1760750624
Name:LEGACY EYE CARE LLC
Entity Type:Organization
Organization Name:LEGACY EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MICHEAL
Authorized Official - Last Name:HUFF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-504-5677
Mailing Address - Street 1:217 CALLE BUENA
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2211
Mailing Address - Country:US
Mailing Address - Phone:706-504-5677
Mailing Address - Fax:
Practice Address - Street 1:217 CALLE BUENA
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2211
Practice Address - Country:US
Practice Address - Phone:706-504-5677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT2584152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty