Basic Information
| Provider Information | |||||||||
| NPI: | 1578097630 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUFFMAN | ||||||||
| FirstName: | REBEKAH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 503 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407411217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068771877 | ||||||||
| FaxNumber: | 6068770082 | ||||||||
| Practice Location | |||||||||
| Address1: | 503 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407411217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068771877 | ||||||||
| FaxNumber: | 6068770082 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2017 | ||||||||
| LastUpdateDate: | 10/17/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | R4441 | KY | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 75546 | WI | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 05183 | KY | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.