Provider Demographics
NPI:1811007354
Name:HUFFMAN, PHILIP DEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:DEAN
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 1:5135 DOVER CENTER RD
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3128
Mailing Address - Country:US
Mailing Address - Phone:440-777-2766
Mailing Address - Fax:440-777-2668
Practice Address - Street 1:5135 DOVER CENTER RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3128
Practice Address - Country:US
Practice Address - Phone:440-777-2766
Practice Address - Fax:440-777-2668
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3127152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
52835OtherDAVIS VISION
OH0031OtherEYE-MED VISION
04469-02-9OtherBCBS OF OHIO
OH0409285Medicaid
13629OtherSPECTERA
341687367026OtherCARESOURCE
000000136692OtherANTHEM BCBS
52835OtherDAVIS VISION
T47052Medicare UPIN
OH0409285Medicaid