MEDICARE: DR. CARRIE NICOLE HUBBELL O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TA1798	MD

General Provider Information

NPI Number	:	1215042742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARRIE NICOLE HUBBELL O.D.

Provider Business Mailing Address
First Line	:	1144 AUGUST DR
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21403-4613
Country	:	US
Telephone Number	:	443-482-3816
Fax Number	:

Provider Business Practice Location Address
First Line	:	509 S CHERRY GROVE AVE
Second Line	:	SPECTACULAR EYE CARE, SUITE C
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-4244
Country	:	US
Telephone Number	:	410-268-4393
Fax Number	:	410-268-5200

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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