Provider Demographics
NPI:1700905619
Name:HORSTMAN, ANTHONY R (OD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:R
Last Name:HORSTMAN
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 1:20 BEAR ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-1955
Mailing Address - Country:US
Mailing Address - Phone:843-341-6688
Mailing Address - Fax:
Practice Address - Street 1:80 BAYLOR DR
Practice Address - Street 2:SUITE 104
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-8900
Practice Address - Country:US
Practice Address - Phone:843-706-3022
Practice Address - Fax:843-706-3027
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1305152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD13055Medicaid
SCT47424Medicare UPIN
SCT474240281Medicare PIN