Provider Demographics
NPI:1124113105
Name:DR. RUSSELL A. HUGHES, OPTOMETRIST, PA
Entity type:Organization
Organization Name:DR. RUSSELL A. HUGHES, OPTOMETRIST, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:828-389-3511
Mailing Address - Street 1:PO BOX 58
Mailing Address - Street 2:
Mailing Address - City:HAYESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28904-0058
Mailing Address - Country:US
Mailing Address - Phone:828-389-3511
Mailing Address - Fax:828-389-3544
Practice Address - Street 1:1091 US HIGHWAY 64 WEST
Practice Address - Street 2:SUITE 2
Practice Address - City:HAYESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28904-0058
Practice Address - Country:US
Practice Address - Phone:828-389-3511
Practice Address - Fax:828-389-3544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1049332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909427Medicaid
NC8909427Medicaid
NC0136550001Medicare NSC
NC246351Medicare ID - Type Unspecified