Provider Demographics
NPI:1427085455
Name:HOUGHTON, STEPHEN M (P A)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:HOUGHTON
Suffix:
Gender:M
Credentials:P A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12640 N KENDALL DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1868
Mailing Address - Country:US
Mailing Address - Phone:305-273-7790
Mailing Address - Fax:305-273-4330
Practice Address - Street 1:9569 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-2802
Practice Address - Country:US
Practice Address - Phone:305-665-3279
Practice Address - Fax:305-661-3435
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0PC1156152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084580900Medicaid
FL19645OtherMEDICARE PTAN