Provider Demographics
NPI:1851158299
Name:HUFF-WADSWORTH, BRETT JOSEPH (LDO)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:JOSEPH
Last Name:HUFF-WADSWORTH
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 SUGAR PL
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-7508
Mailing Address - Country:US
Mailing Address - Phone:727-278-1403
Mailing Address - Fax:
Practice Address - Street 1:1050 E VAN FLEET DR
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-7603
Practice Address - Country:US
Practice Address - Phone:863-533-6073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO7066156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician