Healthcare Provider Details

I. General information

NPI: 1164554903
Provider Name (Legal Business Name): HUB OPTICAL DISTRIBUTING CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3713 FRANKLIN AVE
WACO TX
76710-7329
US

IV. Provider business mailing address

3713 FRANKLIN AVE
WACO TX
76710-7329
US

V. Phone/Fax

Practice location:
  • Phone: 254-752-1081
  • Fax: 254-752-1463
Mailing address:
  • Phone: 254-752-1081
  • Fax: 254-752-1463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3388T
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: LISA E SALGANIK
Title or Position: ADMINISTRATOR
Credential:
Phone: 254-752-1081