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General NPI Number Information
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NPI Number | 1194812008
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Entity Type | Organization
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Legal Business Name | THE OPTOMETRY GROUP, PLLC
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 04/04/2008
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Provider Practice Location Address
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Address Line | 608 TRENT ST NE
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City | NORTON
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State | VA
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Zip | 24273-1532
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Country | US
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Telephone | 276-679-0536
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Fax | 206-279-9117
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Provider Business Mailing Address
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Address Line | 608 TRENT ST NE
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City | NORTON
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State | VA
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Zip | 24273-1532
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Country | US
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Telephone | 276-679-0536
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Fax | 206-279-9117
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Authorized Official
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Title or Position | OWNER
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Name | DR. GARY C. HUBBARD
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Credential | O.D.
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Telephone | 276-679-0536
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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 | 0618001562
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License Number State | VA
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