=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295869204
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RALPH JOHN HUBERT JR. OPTICIAN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31 CENTER ST
-----------------------------------------------------
City | BATAVIA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14020-3242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-343-5660
-----------------------------------------------------
Fax | 585-343-5882
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31 CENTER ST
-----------------------------------------------------
City | BATAVIA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14020-3242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-343-5660
-----------------------------------------------------
Fax | 585-343-5882
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FC0801X
-----------------------------------------------------
Taxonomy Name | Contact Lens Fitter
-----------------------------------------------------
License Number | C003289-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number | C003289-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------