Provider Demographics
NPI:1992718662
Name:HUTTENHOFF, ANDREW ALBERT (OD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:ALBERT
Last Name:HUTTENHOFF
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 1:5599 N ORACLE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-3821
Mailing Address - Country:US
Mailing Address - Phone:520-293-6740
Mailing Address - Fax:520-293-6771
Practice Address - Street 1:5599 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-3821
Practice Address - Country:US
Practice Address - Phone:520-293-6740
Practice Address - Fax:520-293-6771
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12305 T152WC0802X
AZOPT-002329152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV07717Medicare UPIN