MEDICARE: DR. JOEL T HUBBARD O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2003014764	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2003014764	OTHER		MISSOURI LICENSE
2	11814229	OTHER		CAQH

General Provider Information

NPI Number	:	1801952734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL T HUBBARD O.D.

Provider Business Mailing Address
First Line	:	PO BOX 207158
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75320-7158
Country	:	US
Telephone Number	:	636-200-4393
Fax Number	:	636-527-0766

Provider Business Practice Location Address
First Line	:	194 CLARKSON RD
Second Line	:
City	:	ELLISVILLE
State	:	MO
Zip	:	63011-2244
Country	:	US
Telephone Number	:	636-227-2020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	10/11/2022

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