Provider Demographics
NPI:1912210675
Name:BRYAN HUFF O.D., P.C
Entity Type:Organization
Organization Name:BRYAN HUFF O.D., P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:HUFF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:816-318-3937
Mailing Address - Street 1:887 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-8100
Mailing Address - Country:US
Mailing Address - Phone:816-318-3937
Mailing Address - Fax:816-318-3957
Practice Address - Street 1:887 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-8100
Practice Address - Country:US
Practice Address - Phone:816-318-3937
Practice Address - Fax:816-318-3957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000160784152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MODT0779Medicare PIN
MOU8548Medicare UPIN