=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265441448
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR.H.HUBBARD AND ASSOCIATES, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2006
-----------------------------------------------------
Last Update Date | 09/09/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4020 LAFAYETTE RD
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46254-2506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-293-9314
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4020 LAFAYETTE RD
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46254-2506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-293-9314
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | HURST HUBBARD
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 317-293-9314
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 56000242A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------