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General NPI Number Information
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NPI Number | 1285739466
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Entity Type | Individual
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Provider Name | PAUL CLARENCE JUBB OD
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Gender | Male
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 05/16/2019
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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 | 360-482-5033
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Fax |
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Provider Business Mailing Address
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Address Line | 1415 72ND DR SE
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City | LAKE STEVENS
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State | WA
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Zip | 98258-7356
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Country | US
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Telephone | 509-240-4343
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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 | OD00001723
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License Number State | WA
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