Provider Demographics
NPI:1861484487
Name:HUGHES, RUSSELL ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:ALAN
Last Name:HUGHES
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:PO BOX 58
Mailing Address - Street 2:
Mailing Address - City:HAYESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28904-0058
Mailing Address - Country:US
Mailing Address - Phone:828-389-3511
Mailing Address - Fax:828-389-3544
Practice Address - Street 1:1091 HIGHWAY 64 W
Practice Address - Street 2:STE 2
Practice Address - City:HAYESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28904-9657
Practice Address - Country:US
Practice Address - Phone:828-389-3511
Practice Address - Fax:828-389-3544
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1049152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1861484487OtherPERSONAL NPI
NC8909427Medicaid
NC1124113105OtherDME
NCT64893Medicare UPIN
NC8909427Medicaid