Provider Demographics
NPI:1497838601
Name:HUSKEY, RAYMOND WAYNE (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:WAYNE
Last Name:HUSKEY
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1102 HIGHWAY 290 W
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-5423
Mailing Address - Country:US
Mailing Address - Phone:979-836-9811
Mailing Address - Fax:979-836-1212
Practice Address - Street 1:1102 HIGHWAY 290 W
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-5423
Practice Address - Country:US
Practice Address - Phone:979-836-9811
Practice Address - Fax:979-836-1212
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0641840001Medicare NSC