Provider Demographics
NPI:1134867005
Name:HUCKABY, SAVANNAH MERRITT (OD)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:MERRITT
Last Name:HUCKABY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:MERRITT
Other - Last Name:HOLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:301 PROFESSIONAL PARK DR # A
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-5317
Practice Address - Country:US
Practice Address - Phone:870-779-1022
Practice Address - Fax:870-568-0681
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-21
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2859152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist