Provider Demographics
NPI:1215957212
Name:HUSEMAN, BRIAN J (OD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:HUSEMAN
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 1:215 CENTRAL AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-1418
Mailing Address - Country:US
Mailing Address - Phone:502-636-5766
Mailing Address - Fax:502-736-4490
Practice Address - Street 1:215 CENTRAL AVE
Practice Address - Street 2:STE 101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-1418
Practice Address - Country:US
Practice Address - Phone:502-636-5766
Practice Address - Fax:502-736-4490
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1641DT152W00000X
IN18003342152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0959010Medicare ID - Type UnspecifiedMEDICARE NUMBER
KYV08217Medicare UPIN