=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720254774
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMERY C. HUBER, O.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2008
-----------------------------------------------------
Last Update Date | 01/14/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2080 N HWY 360 STE 125
-----------------------------------------------------
City | GRAND PRAIRIE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75050-1400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-633-2020
-----------------------------------------------------
Fax | 214-788-2373
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2080 N HWY 360 STE 125
-----------------------------------------------------
City | GRAND PRAIRIE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75050-1400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-633-2020
-----------------------------------------------------
Fax | 214-788-2373
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. EMERY C. HUBER
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 817-633-2020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152WC0802X
-----------------------------------------------------
Taxonomy Name | Corneal and Contact Management Optometrist
-----------------------------------------------------
License Number | TX2519TG
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------