1700905619 NPI number — DR. ANTHONY R HORSTMAN O.D.

Table of content: DR. ANTHONY R HORSTMAN O.D. (NPI 1700905619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700905619 NPI number — DR. ANTHONY R HORSTMAN O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HORSTMAN
Provider First Name:
ANTHONY
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700905619
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 BEAR ISLAND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILTON HEAD ISLAND
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29926-1955
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-341-6688
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 BAYLOR DR
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
BLUFFTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29910-8900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-706-3022
Provider Business Practice Location Address Fax Number:
843-706-3027
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1305 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: D13055 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com