Provider Demographics
NPI:1215917067
Name:MCHUGH, ROBERT THOMAS (OD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:THOMAS
Last Name:MCHUGH
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 1:137 E 1ST ST
Mailing Address - Street 2:P.O. BOX 854
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1701
Mailing Address - Country:US
Mailing Address - Phone:606-783-1575
Mailing Address - Fax:606-783-1576
Practice Address - Street 1:137 E 1ST ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1701
Practice Address - Country:US
Practice Address - Phone:606-783-1575
Practice Address - Fax:606-783-1576
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY817DT152W00000X
KY0817DT152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77008175Medicaid
KY0431010001Medicare NSC
KYT-54549Medicare UPIN
KY9019801Medicare ID - Type Unspecified