Provider Demographics
NPI:1699832980
Name:HUFF, DOUGLAS L (OD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:L
Last Name:HUFF
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:777 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 129 EAST
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8705
Mailing Address - Country:US
Mailing Address - Phone:314-997-3833
Mailing Address - Fax:314-997-6329
Practice Address - Street 1:777 S NEW BALLAS RD
Practice Address - Street 2:SUITE 129 EAST
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8705
Practice Address - Country:US
Practice Address - Phone:314-997-3833
Practice Address - Fax:314-997-6329
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO2489152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0315890001Medicare NSC
MO410016690Medicare PIN
MOU06136Medicare UPIN
MO000008244Medicare PIN