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General NPI Number Information
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NPI Number | 1164687992
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Entity Type | Organization
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Legal Business Name | DR. PAUL C JUBB PLLC
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Dates
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Enumeration Date | 07/21/2008
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Last Update Date | 05/30/2019
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Provider Practice Location Address
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Address Line | 2301 FREEWAY DR
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City | MOUNT VERNON
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State | WA
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Zip | 98273-5445
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Country | US
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Telephone | 360-428-5033
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Fax |
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Provider Business Mailing Address
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Address Line | 1146 HOBSON ST
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City | WALLA WALLA
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State | WA
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Zip | 99362-2455
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL CLARENCE JUBB
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Credential | O.D.
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Telephone | 509-240-4343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1850 ATI
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License Number State | OR
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