Provider Demographics
NPI:1942378807
Name:HUGHES, PETER FAVREAU (OD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:FAVREAU
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 1:1625 COPPERFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-3753
Mailing Address - Country:US
Mailing Address - Phone:850-894-3029
Mailing Address - Fax:850-671-4243
Practice Address - Street 1:1535 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4605
Practice Address - Country:US
Practice Address - Phone:850-877-7695
Practice Address - Fax:850-671-4243
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC001932152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078428100Medicaid
T85270Medicare UPIN
FL078428100Medicaid