Provider Demographics
NPI:1699469627
Name:HUXTABLE, CHRIS (LDO, ABOC, NCLEC)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:HUXTABLE
Suffix:
Gender:M
Credentials:LDO, ABOC, NCLEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 HUBBARD AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-3841
Mailing Address - Country:US
Mailing Address - Phone:413-442-2734
Mailing Address - Fax:413-442-2811
Practice Address - Street 1:555 HUBBARD AVE STE 12
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-3841
Practice Address - Country:US
Practice Address - Phone:413-442-2734
Practice Address - Fax:413-442-2811
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT028.0133171156FX1800X
MA6862156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician