Provider Demographics
NPI:1780641910
Name:HUG, TIMOTHY E (OD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:E
Last Name:HUG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:TIM
Other - Middle Name:E
Other - Last Name:HUG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3200 E CAMELBACK RD STE 250
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2327
Mailing Address - Country:US
Mailing Address - Phone:602-933-1815
Mailing Address - Fax:
Practice Address - Street 1:1220 S HIGLEY RD STE 106
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4001
Practice Address - Country:US
Practice Address - Phone:602-933-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002422152W00000X, 152WP0200X
MOTO2937152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ080431Medicaid
2695175Medicare ID - Type Unspecified
U43079Medicare UPIN