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General NPI Number Information
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NPI Number | 1194924043
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Entity Type | Individual
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Provider Name | GREGORY PAUL HUBBARD O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 02/11/2011
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Provider Practice Location Address
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Address Line | 1808 E MARKLAND AVE
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City | KOKOMO
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State | IN
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Zip | 46901-6234
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Country | US
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Telephone | 765-457-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 918 S MAPLE ST
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City | GREENTOWN
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State | IN
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Zip | 46936-1666
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Country | US
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Telephone | 765-661-6848
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 18003471A
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License Number State | IN
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