Provider Demographics
NPI:1831680800
Name:HUNTSMAN, ROBERT MICHAEL
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:HUNTSMAN
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 1:800 S HOVER ST STE 34
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-7906
Mailing Address - Country:US
Mailing Address - Phone:303-678-5411
Mailing Address - Fax:303-678-5345
Practice Address - Street 1:800 S HOVER ST STE 34
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-7906
Practice Address - Country:US
Practice Address - Phone:303-678-5411
Practice Address - Fax:303-678-5345
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician